Care of the Child with Musculoskeletal Disorder

Categories: Nursing

About Course

Musculoskeletal complaints in children are common, often benign and self‐limiting, but can be presenting features of significant, severe and potentially life‐threatening conditions.
Making a diagnosis rests on competent clinical skills, knowledge of normal variants, knowledge of common clinical scenarios, ‘red flags’ to suggest severe conditions and judicious use and interpretation of investigations.
Common clinical scenarios include the limping child, ‘growing pains’, back pain and knee pain.
Knowledge of ‘red flags’ to suggest infection, malignancy, multisystem disease and inflammatory joint disorders is important.
The management of musculoskeletal conditions involves a multidisciplinary approach.
Many chronic conditions that begin in childhood continue into adult life, and the process of transitional care to adult services starts in early adolescence.

Differential diagnosis of musculoskeletal pain
Life‐threatening conditions
Malignancy (leukaemia, lymphoma, bone tumour)
Sepsis (septic arthritis, osteomyelitis)
Non‐accidental injury
Joint pain with no swelling
Hypermobility syndromes
Idiopathic pain syndromes (reflex sympathetic dystrophy, fibromyalgia)
Orthopaedic syndromes (e.g. Osgood–Schlatter disease, Perthes’ disease)
Metabolic (e.g. hypothyroidism, lysosomal storage diseases)
Joint pain with swelling
Trauma
Infection
Septic arthritis and osteomyelitis (viral, bacterial, mycobacterial)
Reactive arthritis (postenteric, sexually acquired)
Infection related (rheumatic fever, postvaccination)
Juvenile idiopathic arthritis
Arthritis related to inflammatory bowel disease
Connective tissue diseases (SLE, scleroderma, dermatomyositis, vasculitis)
Sarcoidosis
Metabolic (e.g. osteomalacia, cystic fibrosis)
Haematological (e.g. haemophilia, haemoglobinopathy)
Tumour (benign and malignant)
Chromosomal (e.g. Down’s‐related arthritis)
Autoinflammatory syndromes, e.g. CINCA (Figure 16.1), periodic syndromes, CRMO)
Developmental/congenital (e.g. spondyloepiphyseal dysplasia)