Limb Pain in Children
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Transcript Limb Pain in Children
APPROACH TO LIMB PAIN IN
CHILDREN/OSTEOMYELITIS
MR 7/17/09
J.Chen
Approach to Limb Pain in Children
Approach to Child with Limb Pain
History
History
History
PE
Labs/Imaging
History
Important aspects:
Area involved
# of joints involved
Nature of the pain
Presence of systemic symptoms (fever, rash, weight loss, fatigue)
Presence of limp
Weight bearing status
Morning stiffness
History of past medical illneses
Travel
Family History (Arthritis, Bleeding Disorders, Sickle Cell Disease,
IBD)
Physical Exam
Important Aspects
Joint
Exam
Swelling
Erythema
Warmth
Tenderness
Deformity
ROM
Physical Exam Continue
Adjacent
Structures
Bones
Tendons
Muscles
Skin
Gait
Leg
length discrepancy
Full Neurologic Examination
Basic Screening
CBC with Diff
Blood Smear
ESR
CRP
Radiographs
Imaging
Plain Radiograph and Bone Scan (Technetium-99 scan)
have long been the mainstay for joint and bone
problems
CT useful in diagnosing:
Osseus Tumors
Pelvic and acetabular fractures
Intraarticular Extension of Femoral Fractures
US:
Joint effusions
Developmental dysplasia of the hip
Imaging Continued
MRI-useful in evaluating
Soft
tissue
Joint spaces
Suspected joint infection
Soft tissue tumors
Muscle injuries
Early avasular necrosis
Approach to Limb Pain in Children
Osteomyelitis
Cause:
Most commonly results from Hematogenous spread
May be from direct invasion of Pathogens into the bone.
May be precipitated by trauma
Pathogens:
Staph aureus: 90%
Non-group A beta-hemolytic streptococci
Hib now less prevalent
Salmonella-Sickle Cell Anemia
Pseudomonas aeruginosa-puncture wound
Neisseria gonorrhacae-sexually active
GBS-neonates
Clinical Presentation
Sudden onset
Localized pain
Swelling
Fever
+/- trauma
Limp/refusal to bear weight
Previous infection
Physical Exam
Erythema
Swelling
Point tenderness
Decreased ROM
Most commonly involves
femur>tibia>humerous>fibula>radius>calcaneus>il
ium
Imaging
X-Ray-not helpful in early diagnosis
Findings
appear after 7 days
Soft
tissue swelling
Subperiosteal changes
Bone destruction
Bone Scan-85-100% sensitive
MRI-equal sensitivity, better specificity
Treatment