Common Limb Complaints

Two common and annoying orthopedic problems that we see regularly are growing pains and transient synovitis of the hip.  Both can cause considerable pain and distress but fortunately are otherwise self limited and apparently without any long term implications.

Transient Synovitis of the hip (TS) results from inflammation of the tissue covering the joint (synovium).  It actually can involve any large joint–in particular of the leg–but the large majority of cases involve the hip.  No one knows exactly what causes TS, but as it typically follows URI/viral infections by a few weeks the consensus is that it probably involves some mild, self limited auto-immune issue.  It occurs most typically in children aged 3-8 years with peak at 4-5 years. Children will develop pain and limp fairly abruptly over a day or 2.  The pain may be located in the hip, groin, or buttock and may extend to the knee.  It is very unusual for both sides to be involved.  There may be a mild fever but mostly the children are well appearing. Some children may complain of so much pain that they may at least temporarily be unable to walk.

Lab tests and x-rays are usually normal although on occasion there may be a  small amount of fluid in the joint (effusion) which will invariably resolve on its own.

The only treatment recommended is rest and analgesics like ibuprofen. Infrequently the pain may last for weeks; if so, physical therapy to reduce pain and preserve joint flexibility can be of benefit.

Growing pains are a well defined phenomenon of otherwise vague leg pains.  Nobody knows for sure what causes them either, although my personal guess is that it represents a response to overexertion, with muscle cramps/”Charlie horses.”  Children–or teens–will complain of leg aches and pains at night–NEVER during the day with growing pains.  The pain involves the thighs and calves–NEVER the joints themselves.  These children also are otherwise well appearing–no fevers, rashes , headaches or neck pains, swelling or discoloration of the involved limb.  Growing pains may be an ongoing complaint for some children throughout their early years. As with TS, rest and analgesics are all I recommend; massaging the painful limb often provides good relief as well.  Keep a close eye on activity levels to avoid overexertion. Growing pains ALWAYS resolve by the next morning.

Children with systemic symptoms like high fevers, weakness or fatigue, headaches or neck pains, rashes, multiple joint complaints or ongoing morning stiffness are less likely to have either TS or growing pains. Please call me in these situations so together we can figure out what may be wrong and relieve your child’s discomfort.

Please send along questions or comments, and thanks for following.

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