Cause Of Joint Pain Research Articles

Intra-articular corticosteroid injections for osteoarthritis: A qualitative study of patients' and clinicians' experiences.

Osteoarthritis is a leading cause of joint pain and disability. Intra-articular corticosteroid injections (IACs) are often used in primary care once other recommended treatments have failed. Evidence shows that IACs provide short-term relief of osteoarthritis symptoms, yet little is known about patients' and primary care clinicians' experiences and beliefs about their use. We explored patients' and primary care clinicians' views about IACs, including the benefits, disadvantages, perceived risks of treatment, when they are used, and factors that affect decision-making. We conducted individual interviews with patients and primary care clinicians and used inductive thematic analysis to investigate their views and experiences of intra-articular corticosteroid injections for osteoarthritis (IACs). We interviewed 38 patients and 19 primary care clinicians. We identified 6 patient themes: variation in access; awareness of IACs; views of risk and trust; effectiveness of IACs; variation in onset and effect duration; and an alternative to undesirable treatments. In the interviews with clinicians, we identified an overarching theme of caution and competence, which included eight subthemes: confidence and (dis)comfort with practical procedures; risk of adverse outcomes; training; uncertainty about evidence and guidelines; technical uncertainties; IACs use on the osteoarthritis pathway; perceived benefits and impacts of IACs; and the possibility of placebo. Patients and clinicians valued IACs' potential to relieve symptoms and improve quality of life. Variability in patients' access to treatment appears related to clinicians' confidence in delivering injections and their concerns about the evidence base. Variation in dose frequency and timing reflect clinicians' uncertainty about current guidance. Despite variation in effectiveness patients preferred IACs to other forms of pain medication and to delay or avoid surgery. IACs were mostly used as an adjunct treatment before surgery was offered. These findings can inform further research into the effectiveness of IACs and improvements in information and guidance.

Systemic Juvenile Idiopathic Arthritis and arthralgia - can it be diagnosed early within the window period? – An observation of serum biomarkers and analysis with other differential conditions in children

Background: Systemic juvenile idiopathic arthritis (sJIA)is a cause of persisting arthralgia which is often missed. Diagnosing sJIA can be challenging, especially when overt arthritis is absent at presentation, highlighting the need for a diagnostic biomarker. Few recent studies have assessed potential biomarkers for sJIA, however, there is no consensus in detecting early. We conducted a study evaluating serum IL-1, IL-6, IL-18, S100A8, and S100A9 as potential diagnostic markers to distinguish sJIA from other conditions presenting as joint pain in children. Methods: A prospective study was conducted in our institute from May-2019 to October-2020 in children under 16 years, who had persisting arthralgia. Serum concentrations of IL-1, IL-6, IL-18, S100A9, and S100A8 were determined using ELISA kits. Receiver operating curve (ROC) analysis was used to determine the cut-off values for IL-1, IL-6, IL-18, S100A8, and S100A9 for differentiating sJIA from other causes of joint pain and fever. Results- Out of 47 children who presented with joint pain and fever 19 of them were eventually diagnosed with sJIA. In the other 28 children, arthralgia and fever was attributed to conditions other than sJIA (non-sJIA). The non-sJIA group comprised children with acute lymphoblastic leukemia, hemophagocytic histiocytosis, systemic lupus erythematosus, Kawasaki disease, Kikuchi disease, and inflammatory bowel disease. Serum levels of IL-18, S100A8, and S100A9 were significantly higher in patients with sJIA compared to the non-sJIA group (p<0.05). The area under the curve (AUC) was significant for IL-18(77.9%), S100A8 (74.9%), and S100A9(71.2%). A serum IL-18 cut-off level of > 2030.45 pg/ml was useful for differentiating between sJIA and other diseases with a sensitivity of 66.67% and specificity of 75.86% for the diagnosis of sJIA. Conclusion- Serum IL-18, S100A8, and S100A9 can be useful in differentiating sJIA early from other causes of persisting arthralgia in children provided with appropriate identification of symptomatology and suspicion.

Synthetic Materials Used for Cartilage Regeneration in Recent Decade

Cartilage injury is considered the major cause of joint pain, swelling and dysfunction. Due to the cartilage tissue’s limited repair capacity, it’s very urgent and crucial to develop and investigate biomaterials to improve effective cartilage regeneration. Over the past decade, researchers focused of the design and preparation of a variety of synthetic materials. There synthetic scaffolds are expected to provide a favorable cellular microenvironment which is beneficial for cartilage regeneration. This review comprehensively reviews the major synthetic materials that have been recently applied in cartilage regeneration engineering, including a variety of polymers and a number of 3D printed materials. These materials have unique physicochemical structures and properties that can provide biocompatible three-dimensional porous structures, mimic the extracellular matrix environment in vivo, and promotes cell adhesion, proliferation, and differentiation. These properties all guide the orderly regeneration of cartilage tissues. Especially through the composite with bioactive molecules, nanomaterials, etc., these materials can also realize the controlled release of biological signals and precisely regulate cell behavior. In addition, by compositing natural polymers with synthetic polymers gives the hybrid scaffolds good bioactivity, it will also enhance their mechanical properties as well as the scaffold elasticity. These techniques allow researchers to develop the most ideal scaffold that perfectly mimics the natural cartilage environment.

The Role of MicroRNAs in the Pathophysiology of Osteoarthritis.

Worldwide, osteoarthritis (OA) is the most common cause of joint pain in older people. Many factors contribute to osteoarthritis' development and progression, including secondary osteoarthritis' underlying causes. It is important to note that osteoarthritis affects all four tissues: cartilage, bone, joint capsule, and articular apparatus. An increasingly prominent area of research in osteoarthritis regulation is microRNAs (miRNAs), a small, single-stranded RNA molecule that controls gene expression in eukaryotes. We aimed to assess and summarize current knowledge about the mechanisms of the action of miRNAs and their clinical significance. Osteoarthritis (OA) is affected by the interaction between miRNAs and inflammatory processes, as well as cartilage metabolism. MiRNAs also influence cartilage cell apoptosis, contributing to the degradation of the cartilage in OA. Studies have shown that miRNAs may have both an inhibitory and promoting effect on osteoporosis progression through their influence on molecular mechanisms. By identifying these regulators, targeted treatments for osteoarthritis may be developed. In addition, microRNA may also serve as a biomarker for osteoarthritis. By using these biomarkers, the disease could be detected faster, and early intervention can be instituted to prevent mobility loss and slow deterioration.

Imaging Review of Different Subchondral Insufficiency Fractures.

Subchondral fractures are a common cause of joint pain that may ultimately lead to articular collapse and the need for arthroplasty. This type of fracture has been reported at multiple joints throughout the body. While clinical and radiographic resolution can be achieved, progressive bone collapse can occur and lead to a variety of complications. Understanding the pertinent imaging findings can aid in the early evaluation of subchondral fractures and in the prevention of their associated complications.

Evaluating Factors Associated With Telehealth Appropriateness in Outpatient Rheumatoid Arthritis Encounters Using the Encounter Appropriateness Score for You (EASY).

Telehealth has been proposed as a safe and effective alternative to in-person care for rheumatoid arthritis (RA). The purpose of this study was to evaluate factors associated with telehealth appropriateness in outpatient RA encounters. A prospective cohort study (January 1, 2021, to August 31, 2021) was conducted using electronic health record data from outpatient RA encounters in a single academic rheumatology practice. Rheumatology providers rated the telehealth appropriateness of their own encounters using the Encounter Appropriateness Score for You (EASY) immediately following each encounter. Robust Poisson regression with generalized estimating equations modeling was used to evaluate the association of telehealth appropriateness with patient demographics, RA clinical characteristics, comorbid noninflammatory causes of joint pain, previous and current encounter characteristics, and provider characteristics. During the study period, 1823 outpatient encounters with 1177 unique patients with RA received an EASY score from 25 rheumatology providers. In the final multivariate model, factors associated with increased telehealth appropriateness included higher average provider preference for telehealth in prior encounters (relative risk [RR] 1.26, 95% CI 1.21-1.31), telehealth as the current encounter modality (RR 2.27, 95% CI 1.95-2.64), and increased patient age (RR 1.05, 95% CI 1.01-1.09). Factors associated with decreased telehealth appropriateness included moderate (RR 0.81, 95% CI 0.68-0.96) and high (RR 0.57, 95% CI 0.46-0.70) RA disease activity and if the previous encounters were conducted by telehealth (RR 0.83, 95% CI 0.73-0.95). In this study, telehealth appropriateness was most associated with provider preference, the current and previous encounter modality, and RA disease activity. Other factors like patient demographics, RA medications, and comorbid noninflammatory causes of joint pain were not associated with telehealth appropriateness.

Assessment of patients with painful joints

Joint pain makes up a significant proportion of presentations to general practice. Causes range from minor mechanical issues to serious conditions such as septic arthritis. Clues from the history such as onset, progression, and extra-articular symptoms aid diagnosis. Many cases of joint pain are appropriately investigated and managed in general practice, but some presentations require referral to secondary care, such as those with signs or symptoms of inflammatory arthritis. It is crucial that red flags for serious or life-threatening causes of joint pain are identified and acted upon urgently.

Hospital Admission Profile Due to Osteoarthritis: An Ecological Study.

Background Osteoarthritis (OA) is also known as degenerative joint disease and is considered the major cause of joint pain and disability. Furthermore, OA is the most common, costly, and disabling form of joint diseases. The objective of this study is to explore the hospital admission profile due to OA between the period 1999 and 2019 in England and Wales. Method This is an ecological study that used health care data in the United Kingdom. Patients who were hospitalized for OA in England and Wales between 1999 and 2019 formed the study population. The Hospital Episode Statistics in England and the Patient Episode Database for Wales databases were used in this study. The difference in the admission rate during the study period was estimated using the chi-squared test. Results The admission rate during the study period increased by 112.1% for all hospital admission related to OA. The most common type of admission was related to gonarthrosis, which accounted for 46.7% of the total number of admissions for OA. The increase in admission rate across different types of admissions related to OA was not consistent. The highest increase in the admission rate was observed for polyarthrosis (604.6%). Admission rates related to OA were observed to be directly related to age. The highest increase in the admission rate during the study period was for the age group of 15-59 years (102.1%). Admission rate due to OA was higher among females compared to males. Conclusion The increase in admission rates for the various OA-related admissions was not consistent. This study found that the age range of 15 to 59 years experienced the greatest increase in admission rates. Female gender is a high risk factor for OA, especially in women around menopause.

Review of Osteoarthritis-related Medicinal Herbs

Abstract: One of the most common causes of joint pain and impairment is osteoarthritis. Osteoarthritis is a condition that affects people all over the world. Osteoarthritis is the second most prevalent and commonly diagnosed rheumatologic disease in India, with a prevalence of 22 to 39 %. Prior to the discovery of extraction and synthetic chemistry, musculoskeletal diseases were treated using medicinal plant compositions. When non-pharmacological therapy is insufficient, a variety of pharmacological therapies can be used to treat arthritis. Synthetic medication therapy, on the other hand, may have undesirable side effects and be expensive. As a result, researchers have been looking at alternative therapies. Herbal drugs have demonstrated the ability to control arthritis in a safe and effective manner. In this review, the safety and efficacy traditionally used plants and main chemical constituents to treat osteoarthritis are reported. After reviewing online databases, we found herbs used to treat osteoarthritis such as Boswellia serrata, Alpinia galanga, Commiphora wightii, Harpagophytum procumbens, Salix alba, Ribes nigrum L., Filipendula ulmaria, Curcuma longa, Zingiber officinale, Capsicum annum, Urtica dioica L., Vitex negundo L., Syzygium aromaticum L. and Allium sativum L. These species are attributed with antioxidant and anti-inflammatory properties, which helped to reduce inflammation and tissue damage. The efficacy and safety of herbal medications for osteoarthritis symptoms are discussed here.

Orthobiologic Treatment of Ligament Injuries.

Ligament injuries are common causes of joint pain, dysfunction, and disability resulting in disruption of joint homeostasis. Ligament injuries have historically been treated surgically. The autologous orthobiologic preparation used for treatment can influence the varying results reported. Therefore, to truly understand and compare results of these powerful therapies, reporting standardization, such as harvesting techniques, concentration techniques, quantification of the delivered product (platelets, progenitor cells), formulations (leukocyte content), number of injections performed, activation, injection technique (guided vs unguided), in addition to the post treatment rehabilitation process, are all important and necessary to evaluate and compare efficacy of future studies.

Лечение остеоартроза коленных суставов на основе применения клеточных технологий

Osteoarthritis (OA) is the most common chronic disease of joint and a major cause of joint pain and disability. Traditional therapies for knee osteoarthritis show little clinical benefit, and the terminal treatment option is joint replacement. Currently, cell therapy is prospective for the treatment of knee osteoarthritis and has shown significant results in animal studies and human clinical trials. The aim: to investigate the treatment results in patients with knee osteoarthritis using adipose tissue stromal-vascular fraction and synovial mesenchymal stem cells.Methods. 60 patients with knee osteoarthritis were included in the study. The stage of knee osteoarthritis was assessed using the Kellgren-Lawrence classification, and patients with stage II-III of osteoarthritis were included in this study. After arthroscopic debridement, patients were divided into 2 groups. The first group was injected with the stromal-vascular fraction (SVF) of synovial membrane, and the second group was injected with adipose tissue mesenchymal stem cells (SVF). The minimum clinical and radiologic follow-up period was 12 months. Results. The assessment of the joints condition after 12 months using different scales showed that in both experimental groups there was a significant improvement of the functional status of the knee of the patients after treatment with MSC and SVF. Functional indicators of knee joints on the WOMAC scale improved by 14.7 and 13.4, on the KOOS scale by 23.6 and 26.4 in the SVF and MSC groups, respectively. Pain syndrome regressed by 1.8 and 2.1 on the VAS scale in the SVF and MSC groups, respectively.Conclusion. The results of both study groups showed that there is a significant difference between WOMAC, VAS and KOOS values before and after surgery (8, 12 weeks and 12 months) in the compared groups towards improvement

Osteoarthritis of the Knee and Osteoporosis Therapy Advances in Chinese Medicine

With the aging of the population, the incidence of osteoarthritis of the knee combined with osteoporosis is increasing year by year in China, and it is one of the main causes of joint pain and loss of working ability in middle-aged and elderly patients. There is a practical need and demand to actively investigate the prevention and treatment of osteoarthritis of the knee combined with osteoporosis. Modern medicine has not yet developed a holistic and unified treatment principle for this disease. Chinese medicine is experienced in treating this disease with obvious advantages and various modalities, including Chinese internal medicine, Chinese external medicine, Chinese physical therapy, Gong practice, and integrative therapy, which are hereby reviewed.

PSAT159 Does Untreated Hypercalcemia Affect Postoperative Joint Pain Following Hip and Knee Arthroplasty for Osteoarthritis? A Retrospective Case Cohort Study

Abstract Background/Objective Primary hyperparathyroidism (pHPT) is characterized by the excess secretion of parathyroid hormone (PTH), leading to hypercalcemia. pHPT is a known cause of joint pain, which is the key element in the decision regarding possible arthroplasty in patients with osteoarthritis (OA). The effect of hypercalcemia on arthroplasty outcomes has not been studied. This study investigates the association between preoperative hypercalcemia and postoperative outcomes following total knee (TKA) and total hip arthroplasty (THA). Methods A retrospective chart review was conducted on patients who underwent initial elective THA and/or TKA at an academic medical center between 2015-2019. Patient characteristics and outcomes were obtained. Hypercalcemia was used as a proxy for pHPT as PTH is not routinely obtained in the orthopedic setting. Patients with a preoperative serum calcium >10.2 mg/dL were matched (1: 2-1: 4) with nearest neighbor matching to patients with normal serum calcium based on age, sex, BMI, Charlson Comorbidity Index, American Society of Anesthesiologists class, type of surgery (hip or knee), and date of surgery. THA and TKA functional outcomes were measured at baseline and one-year postoperatively using patient-reported Hip Disability and Osteoarthritis Outcome Scores (HOOS JR) and Knee Injury and Osteoarthritis Outcome Scores (KOOS JR) surveys, respectively. A score of '0' represents total joint disability; '100' represents perfect joint health. Patients with incomplete HOOS JR or KOOS JR scores were excluded. Postoperative complications, readmissions, length of stay, and functional outcome scores were compared. Results Of 5215 patients identified, 269 (5%) were hypercalcemic. The final cohort included 495 patients (106 [21%] hypercalcemic cases, 389 matched controls). Of these, 223 patients underwent THA (46 [21%] cases; 177 controls) and 272 patients underwent TKA (61 [22%] cases; 211 controls). There were no differences in HOOS JR and KOOS JR scores between cases and controls at baseline (HOOS JR: 49.6±12.9 vs 52.8±13.3; KOOS JR: 52.5±12.1 vs 53.5±11.4) or at one-year postoperatively (HOOS JR: 83.6±16.2 vs 84.7±15.5; KOOS JR: 78.0±13.1 vs 75.5±15.3). There also were no differences in rates of postoperative complications, readmissions, or length of stay. Only 19/106 (18%) hypercalcemic patients had a PTH drawn, and of these, 9 (47%) had possible pHPT (PTH>40). Sub-analysis of these 9 patients demonstrated similar HOOS JR and KOOS JR scores to controls at both timepoints. Conclusion Patients with hypercalcemia undergoing arthroplasty have similar functional and postoperative outcomes as normocalcemic patients. Analysis of patients with possible pHPT was limited, as a PTH was obtained in <20% of patients with hypercalcemia. However, nearly 50% of these patients had possible pHPT. Therefore, we recommend that all patients being evaluated for arthroplasty have a calcium level checked, and if high, be evaluated for possible pHPT. Additional investigation is needed to determine the effect of pHPT on arthroplasty outcomes. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Poster 268: Allogeneic, Off The Shelf, Bone Marrow derived, Pooled, Mesenchymal Stromal Cells – A Potential Break through Therapy for Grade II & III Osteoarthritis Knee Management

Poster 268: Allogeneic, Off The Shelf, Bone Marrow derived, Pooled, Mesenchymal Stromal Cells – A Potential Break through Therapy for Grade II & III Osteoarthritis Knee Management

Function of arthroscopy for early diagnosis and early therapeutic intervention in knee synovitis compared to histopathology

Background and Aim: Osteoarthritis (OA) is the most common form of arthritis and a major cause of joint pain and disability. Synovial fluid analysis and biopsy have been found to be a valuable adjunct to conventional investigations and are routinely advised in most cases of joint diseases. Needle arthroscopy of the knee has been advocated as it allows good macroscopic evaluation of synovial inflammation and selective sampling of the synovial membrane thereby overcoming the disadvantage of closed needle biopsy.Material and Methods: In the decided study period, total of 60 cases were selected as per the inclusion and exclusion criteria decided prior to the start of the study. The clinical examination with movements in knee joints, valgus stress test, lachman test amd McMurrays test was done. After initial arthroscopic inspection, the structures like anterior cruciate ligament, medial and lateral menisci, tested and seen for their integrity and consistency. The synovial fluid was sent for cytology, culture and for biochemistry. The data was analyzed using proportions.Results: Overall in 24 cases the clinical diagnosis differed from that of gold standard i.e. histopathology. In six cases the diagnosis was chronic non-specific synovitis but it turned out to be Osteoarthritis on histopathology. In two cases the clinical diagnosis was chronic non-specific synovitis but it turned out to be pyogenic synovitis on histopathology. In two cases the clinical diagnosis was chronic non-specific synovitis but it turned out to be Villonodular synovitis s on histopathology. In six cases the diagnosis was septic arthritis but it turned out to be gouty arthritis on histopathology.Conclusion: Thus arthroscopic diagnosis can be relied upon and treatment can be started on this basis in view of time consuming and costly histopathological tests.

Evaluation of non-articular causes of shoulder pain

Background: To evaluate the accuracy of high resolution ultrasound (USG) and MRI in the diagnosis of rotator cuff tears (RCT) and to determine if high resolution USG compares favorably in sensitivity and specificity to MRI in the diagnosis of non-articular causes of joint pain. Material/Methods: In this prospective comparative study, 52 patients with clinically suspected rotator cuff tears underwent both ultrasound and MRI of the shoulder. The USG and MRI were interpreted by two radiologists experienced in musculoskeletal radiology and blinded to findings of each other. Comparison was done using MRI as a standard reference. Results: The agreement between USG and MRI for diagnosis of RCTs was statistically significant ; USG showed a sensitivity of 90.6% and a specificity of 75% for tendinopathy, a sensitivity of 64.3% and a specificity of 81.6% for partial-thickness tears, a sensitivity of 41.7% and a specificity of 90% for complete width full-thickness tears and a sensitivity of 40% and a specificity of 95.7% for incomplete width full-thickness tears; diagnostic efficacy for all cases with tears was 80.8%. Conclusion: Considering the comparable diagnostic efficacy of USG and MRI, the former modality can be used as a first-line investigation for diagnosis of RCT.

Concept of Inflammatory Joint Pain in Ayurveda - A Review

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is said to be nature’s earliest sign of morbidity and it is prominent among all the other sensory experiences by which an individual can identify the presence of a pathological condition in them. In the condition related to musculo-skeletal system, pain is an important symptom. The most common cause of joint pain is either inflammation or degeneration. Some of the conditions with joint pain due to inflammation are Rheumatoid Arthritis (RA), psoriatic arthritis, ankylosing spondylitis, Systemic Lupus Erythematous (SLE), Gouty arthritis. References regarding different conditions related to Joint is seen in the context of many systemic diseases like Jwara, Atisara, Grahani, Pandu, to mention a few, and Sandhi (joints) related diseases like Amavata, Vatarakta, Vatavyadhi and Kroshtukaseersha, in Ayurveda. The Samprapti (pathogenesis) can be thought to be due to the involvement of Tridoshas, Ama and Rakta. Due to the Khavaigunya and Vakrata of the Sandhis, they get lodged at the Sandhi Pradesha resulting in symptoms of Inflammatory Arthritis such as Vedana (pain), Sopha (swelling), Raga (redness) and Sparshasahishnuta (tenderness) in Sandhi.

Pediatric Orthopedic Emergencies

Proper care of orthopedic injuries and emergencies in children and adolescents requires knowledge of the altered bone and ligament characteristics, varying stages of skeletal development, and potential for congenital or developmental abnormalities. Pediatric fractures affecting the growth plate require unique management to maintain optimal growth. Whereas some specific fractures in these skeletally immature patients require urgent surgical repair, other fractures remodel extremely well and can be managed with a simple splint. Particular dislocations are common in this population and may have concomitant fractures. There are several overuse injuries seen primarily in children, and treatment aims to keep the patient active while allowing the injury to heal. Potentially devastating osteoarticular infections occur in the pediatric population and must be differentiated from more benign causes of joint pain, such as transient synovitis or congenital abnormalities. Children are also at risk for abnormalities such as slipped capital femoral epiphysis or Legg-Calvé-Perthes disease, which are rarely diagnosed in the adult population. It is imperative for a clinician to be aware of these and other nuances to optimally care for orthopedic injuries and emergencies in the pediatric population. This review contains 9 figures, 13 tables and 45 references Key words: bone, musculoskeletal, orthopedic, skeletal

Pediatric Orthopedic Emergencies

Proper care of orthopedic injuries and emergencies in children and adolescents requires knowledge of the altered bone and ligament characteristics, varying stages of skeletal development, and potential for congenital or developmental abnormalities. Pediatric fractures affecting the growth plate require unique management to maintain optimal growth. Whereas some specific fractures in these skeletally immature patients require urgent surgical repair, other fractures remodel extremely well and can be managed with a simple splint. Particular dislocations are common in this population and may have concomitant fractures. There are several overuse injuries seen primarily in children, and treatment aims to keep the patient active while allowing the injury to heal. Potentially devastating osteoarticular infections occur in the pediatric population and must be differentiated from more benign causes of joint pain, such as transient synovitis or congenital abnormalities. Children are also at risk for abnormalities such as slipped capital femoral epiphysis or Legg-Calvé-Perthes disease, which are rarely diagnosed in the adult population. It is imperative for a clinician to be aware of these and other nuances to optimally care for orthopedic injuries and emergencies in the pediatric population. Key words: bone, musculoskeletal, orthopedic, skeletal

Pediatric Orthopedic Emergencies

Proper care of orthopedic injuries and emergencies in children and adolescents requires knowledge of the altered bone and ligament characteristics, varying stages of skeletal development, and potential for congenital or developmental abnormalities. Pediatric fractures affecting the growth plate require unique management to maintain optimal growth. Whereas some specific fractures in these skeletally immature patients require urgent surgical repair, other fractures remodel extremely well and can be managed with a simple splint. Particular dislocations are common in this population and may have concomitant fractures. There are several overuse injuries seen primarily in children, and treatment aims to keep the patient active while allowing the injury to heal. Potentially devastating osteoarticular infections occur in the pediatric population and must be differentiated from more benign causes of joint pain, such as transient synovitis or congenital abnormalities. Children are also at risk for abnormalities such as slipped capital femoral epiphysis or Legg-Calvé-Perthes disease, which are rarely diagnosed in the adult population. It is imperative for a clinician to be aware of these and other nuances to optimally care for orthopedic injuries and emergencies in the pediatric population. Key words: bone, musculoskeletal, orthopedic, skeletal