Musculoskeletal Conditions In Children Research Articles

Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip: Risk Assessment Tool.

Background and Objectives: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions in children. If not treated, it leads to disability, gait abnormalities, limb shortening, and chronic pain. Our study aims to determine the impact of multiple risk factors on the incidence of DDH and to develop an interactive risk assessment tool. Materials and Methods: We conducted a retrospective cohort study in the Outpatient Clinic for Children of the Medical University of Warsaw Hospital. The Graf classification system was used for universal ultrasonographic screening. In total, 3102 infants met the eligibility criteria. Results: The incidence of DDH in the study group was 4.45%. The incidence of DDH in the Warsaw population, Poland, during the study period was 3.73 to 5.17 (95% CI). According to the multivariate analysis, the risk factors for DDH were birth weight (OR = 2.17 (1.41–3.32)), week of delivery (OR = 1.18 (1.00–1.37)), female sex (OR = 8.16 (4.86–13.71)), breech presentation (OR = 5.92 (3.37–10.40)), physical signs of DDH (25.28 (8.77–72.83)) and positive family history in siblings (5.74 (2.68–12.31)). Our results support the recent hypothesis that preterm infants (<37 weeks) have a lower rate of DDH. Conclusions: A multivariate logistic regression predictive model was used to build the risk calculator. The DDH risk calculator will be evaluated in a prospective validation study.

Musculoskeletal Education: An Assessment of the Value of the American Academy of Pediatrics Musculoskeletal Boot Camp Course in Improving Clinical Confidence of Pediatricians Managing Common Musculoskeletal Conditions

In 2016, the American Academy of Pediatrics Section on Orthopaedics established an annual Musculoskeletal (MSK) Boot Camp course to fill the gaps in MSK knowledge, performance, and outcomes for pediatricians and primary care doctors. A standardized one-day curriculum of key MSK topics was developed including short lectures, hands-on workshops, debates, live webinars, and Q&A sessions. A survey was created to evaluate attendee confidence related to diagnosing 20 common MSK conditions in children and adolescents at the beginning and end of the course. Confidence in diagnosing the conditions was gauged using a 6-point Likert-type scale. A two-sample t test was used to compare overall confidence score pre- and post-seminar. In addition, each subtopic was analyzed. The average pre-seminar confidence score was 3.92 versus 4.86 post-seminar. All categories demonstrated a statistically increased confidence score post-seminar (P < .0001). Live MSK continuing education for pediatricians is effective in improving confidence in clinical practice.

Sleep problems and psychological symptoms as predictors of musculoskeletal conditions in children and adolescents.

Population-based studies show that sleep problems and psychological symptoms may increase the risk of musculoskeletal pain onset in children/adolescents. However, there is no evidence of these associations within primary care settings, where interventions can take place. This study investigated whether children/adolescents who consulted their general practitioner for sleep problems or psychological symptoms are at higher risk of subsequent consultations for musculoskeletal conditions. This prospective matched-cohort study used electronic medical records of children/ adolescents (aged 6-19years) from a UK primary care database. Associations between a consultation for sleep problems or psychological symptoms at baseline and a subsequent consultation for musculoskeletal conditions within the 2-year follow-up were investigated using survival analysis, producing hazard ratio (HR) and 95% confidence interval (CI) with adjustment for confounders. Children/adolescents who consulted for sleep problems had a significant increased risk of consultation for musculoskeletal conditions (HR=1.72; 95% CI 1.14, 2.60), which became nonsignificant after adjustment for confounders (HR=1.49; 95% CI 0.98, 2.27). Children/adolescents who consulted for psychological symptoms had a significant increased risk of consultation for musculoskeletal conditions (HR=1.59; 95% CI 1.31, 1.93), which was attenuated after adjustment (HR=1.39; 95% CI 1.14, 1.70). Children and adolescents who visit primary care for sleep problems or psychological symptoms have increased risk of future musculoskeletal consultations. Further work is needed to understand the causal mechanisms that explain these associations, before designing interventions strategies within primary care settings. Population-based studies showed that sleep problems and psychological symptoms may be important precursors of musculoskeletal pain in children and adolescents. By investigating these associations in primary care settings, this study showed that children and adolescents with consultations for sleep problems or psychological symptoms were at increased risk of subsequent consultations for musculoskeletal conditions. These findings support results from population-based studies, and identify potential areas for further research and potential intervention within primary care.

Differences in Adipose Tissue and Lean Mass Distribution in Patients with Collagen VI Related Myopathies Are Associated with Disease Severity and Physical Ability.

Mutations in human collagen VI genes cause a spectrum of musculoskeletal conditions in children and adults collectively termed collagen VI-related myopathies (COL6-RM) characterized by a varying degree of muscle weakness and joint contractures and which include Ullrich Congenital Muscular Dystrophy (UCMD) and Bethlem Myopathy (BM). Given that collagen VI is one of the most abundant extracellular matrix proteins in adipose tissue and its emerging role in energy metabolism we hypothesized that collagen VI deficiency might be associated with alterations in adipose tissue distribution and adipokines serum profile. We analyzed body composition by means of dual-energy X-ray absorptiometry in 30 pediatric and adult COL6-RM myopathy patients representing a range of severities (UCMD, intermediate-COL6-RM, and BM). We found a distinctive pattern of regional adipose tissue accumulation which was more evident in children at the most severe end of the spectrum. In particular, the accumulation of fat in the android region was a distinguishing feature of UCMD patients. In parallel, there was a decrease in lean mass compatible with a state of sarcopenia, particularly in ambulant children with an intermediate phenotype. All children and adult patients that were sarcopenic were also obese. These changes were significantly more pronounced in children with collagen VI deficiency than in children with Duchenne Muscular Dystrophy of the same ambulatory status. High molecular weight adiponectin and leptin were significantly increased in sera from children in the intermediate and BM group. Correlation analysis showed that the parameters of fat mass were negatively associated with motor function according to several validated outcome measures. In contrast, lean mass parameters correlated positively with physical performance and quality of life. Leptin and adiponectin circulating levels correlated positively with fat mass parameters and negatively with lean mass and thus may be relevant to the disease pathogenesis and as circulating markers. Taken together our results indicate that COL6-RM are characterized by specific changes in total fat mass and distribution which associate with disease severity, motor function, and quality of life and which are clinically meaningful and thus should be taken into consideration in the management of these patients.

Musculoskeletal Conditions in a Pediatric Population with Ehlers-Danlos Syndrome

To describe musculoskeletal conditions in children with Ehlers-Danlos syndrome (EDS). A retrospective medical record review was performed, which evaluated 205 patients with EDS (ages 6-19 years) seen in sports medicine or orthopedic clinic at a large pediatric hospital over a 5-year period. Female (n = 147) and male (n = 57) patients were identified (mean age 12.7 years). The most common EDS subtype (55.6%) was hypermobility type. Patients had between 1 and 69 visits (median 4), and 764 diagnoses were recorded, most commonly laxity/instability, pain, subluxation, and scoliosis/spinal asymmetry. Nearly one-half of patients (46.8%) received a general diagnosis of pain because no more specific cause was identified, in addition to 8.3% who were diagnosed with chronic pain syndrome. The most common sites of presenting issue were knee (43.4%), back (32.2%), and shoulder (31.2%). Over three-fourths (77.1%) of patients had imaging. Most (88.1%) were prescribed physical therapy and/or other conservative measures, such as rest (40.5%), orthotics (35.6%), and medication (32.2%). Surgery was recommended to 28.8% of the study population. Many pediatric and adolescent patients with EDS experience joint pain, instability, and scoliosis, along with other musculoskeletal issues. Despite extensive workup, the etiology of pain may not be identified. Large numbers of office visits, imaging studies, treatment prescriptions, and specialist referrals indicate considerable use of medical resources and highlight a great need for injury prevention and additional study.

Dor no tornozelo – Um caso de Síndroma Os trigonum

Introduction: Diagnosing painful osteoarticular or musculoskeletal conditions in children and teenagers is often a challenge. Ankle pain is a frequent complaint but the Os trigonum syndrome is rarely considered. Case report: We report the case of an 18 year-old boy who complained of frequent ankle pain. Physical examination and x-ray examination were inconclusive, without remarkable changes. However, the persistence of complaints and the history of an injury led to CT scanning, which revealed an Os trigonum. Comment: This article presents the differential diagnosis of posterior ankle pain and focuses on the Os trigonum Syndrome

The evidence base for chiropractic treatment of musculoskeletal conditions in children and adolescents: The emperor's new suit?

Five to ten percent of chiropractic patients are children and adolescents. Most of these consult because of spinal pain, or other musculoskeletal complaints. These musculoskeletal disorders in early life not only affect the quality of children's lives, but also seem to have an impact on adult musculoskeletal health. Thus, this is an important part of the chiropractors' scope of practice, and the objective of this review is to assess the evidence base for manual treatment of musculoskeletal disorders in children and adolescents.Randomized, quasi-randomized and non-randomized clinical studies were included if they investigated the effect of manual therapy on musculoskeletal disorders in children and/or adolescents. The MEDLINE and MANTIS databases were searched, and studies published in English, Danish, Swedish or Norwegian were included.Only three studies were identified that in some way attempted to look at the effectiveness of manual therapy for children or adolescents with spinal problems, and none of these was a randomized controlled clinical trial. As for the rest of the musculoskeletal system, only one study of temporomandibular disorder was identified.With this review, we have detected a paradox within the chiropractic profession: Although the major reason for pediatric patients to attend a chiropractor is spinal pain, no adequate studies have been performed in this area. It is time for the chiropractic profession to take responsibility and systematically investigate the efficiency of joint manipulation of problems relating to the developing musculoskeletal system.

Chiropractic care for children: too much, too little or not enough?

This editorial provides an overview of this Thematic Series of the journal titled Chiropractic Care for Children. In commissioning this series of articles we aimed to bring the busy clinician up to date with the current best evidence in key aspects of evaluation and management of chiropractic care for children. Individual articles address a chiropractic approach to the management of children, chiropractic care of musculoskeletal conditions in children and adolescents, chiropractic care of non-musculoskeletal conditions in children and adolescents, chiropractic care for attention-deficit/hyperactivity disorder and possible adverse effects from chiropractic management of children. The final article by Charlotte Leboeuf-Yde and Lise Hestbæk is an overview of the current state of the evidence and future research opportunities for chiropractic care for children. We conclude this editorial discussing the strengths and weaknesses of contemporary research relevant to chiropractic care of children and the implications for chiropractic practice.

Epidemiology of Surgical Admissions to a Children’s Disability Hospital in Nepal

The goal of this retrospective review was to characterize the spectrum of surgical admissions to a tertiary hospital specializing in musculoskeletal conditions in children and adolescents in Nepal. We reviewed hospital records from 1996 to 2006 to categorize all major surgical procedures. Additional information collected included diagnosis, patient age, gender, and home district. Of 7,556 major surgical procedures performed from 1996 to 2006, 91% could be placed within the following categories: congenital (n = 2,984; 38%), burn contracture (n = 1,400; 19%), posttraumatic (n = 1,047; 14%), neuromuscular (n = 750; 10%), and infection (n = 731; 10%). The most common diagnosis was congenital clubfoot, which accounted for 2,348 cases (31%). Thirty-three percent of cases (n = 2,447) involved injuries (burns, fractures, dislocations). While burns most commonly involved the upper extremity, fractures in the elbow region were the most frequent posttraumatic problem. The most common neuromuscular diagnosis was poliomyelitis. The sequelae of musculoskeletal sepsis represented 731 cases (10%), most commonly chronic osteomyelitis. Other diagnoses termed miscellaneous included angular deformities of the lower extremities, scoliosis and other spinal deformities, hip dysplasia, and tumors. The majority of surgical pathology involved injuries and congenital problems (mainly clubfoot). The presentation was delayed in most patients, and in such cases, the treatment is more complex and costly, and the desired functional outcome is difficult to achieve. In addition to preventive measures, morbidity cases could have been reduced by the timely provision of services at the primary referral level. Strengthening the delivery of basic orthopedic services at primary health care facilities may eliminate or reduce the need for complex reconstructive procedures and diminish the likelihood of permanent disability in our population.

Principles of management of musculoskeletal conditions in children and young people

Musculoskeletal symptoms and rheumatic conditions are common throughout childhood and adolescence. Age- and development-appropriate care and management of children and young people with such conditions is vital, acknowledging that they are NOT small adults! The major aspect of both paediatric and adolescent rheumatology care which differentiates it from adult care is the fact that children and young people are still growing, in contrast to the ageing and senescence which characterizes adult rheumatology. Growth must be considered in the global sense, incorporating cognitive and psychosocial growth as well as physical growth. Likewise, the reciprocal influences of growth and a chronic rheumatic condition should be considered when caring for young people with childhood-onset rheumatic disease. This chapter will detail the general principles of management of such symptomatology with primary reference to chronic conditions.

State of the art: Juvenile idiopathic arthritis

Juvenile idiopathic arthritis (JIA) is the most common of the autoimmune musculoskeletal conditions in children. As awareness of this condition increases, so too does the apparent prevalence reported from countries around the world, suggesting that significant numbers of children with JIA have previously gone undiagnosed. Prevalence varies with race and possibly geography. However, JIA should no longer be considered as a rare condition. In the past decade, there have been definite advances in understanding the pathogenesis of JIA, and there have been parallel advances in therapies. There have been fairly modest advances in the classification of JIA, but there is at least heightened international debate on the issue, which will lead to progress. It is estimated that nearly one-third of children with this condition continue into adult life with inflammatory joint disease, and therefore the burden of disease remains significant.

Musculoskeletal conditions in children attending two Togolese hospitals.

A retrospective study was conducted in order to point out the different kinds of musculoskeletal conditions observed in children attending two Togolese hospitals. A total of 434 (242 females, 192 males) of the 29 620 children examined (1.5%) were suffering from these conditions. Probable joint and bone infections (187 patients, 43%), limb deformities (106 patients, 24%), osteochondrosis (60 patients, 14%) and vaso-occlusive crisis due to haemoglobinopathies (29 patients, 7%) were the main conditions observed. Osteomyelitis observed in 128 patients affected the humerus (25 patients), radius (10 patients), femur (68 patients), tibia (15 patients), fibula (five patients), and both tibia and fibula (five patients). Probably, infectious arthritis seen in 30 patients affected mainly the hip (11 patients) and the knee (13 patients). In the spine, infection affected the midthoracic and upper lumbar areas. Underdevelopment, sickle cell anaemia and sickle cell haemoglobin C disease were the main risk factors in determining susceptibility to infections. Vaso-occlusive crises were due to sickle cell anaemia (11 patients) and sickle cell haemoglobin C disease (18 patients). Osteochondrosis seen in 60 patients free from haemoglobinopathy involved the spine (Scheuermann's disease, 38 patients) and the hip (Legg-Calvé-Perthes disease, 22 patients). Limb deformities were observed in the knee (varus and valgus deformities in 64 patients) and the foot (talipes varus equin in 40 patients). This study's findings, which require further confirmation, suggest some conclusions. Scheuermann's disease can explain in part the degenerative disc conditions observed in African adults. Valgus and varus deformities play an important role in the development of knee osteoarthritis in Black Africa. An African child with joint or bone pain should be investigated for sickle cell anaemia. In the future, improved lifestyle and better health care will be essential to reduce bone and joint infections, and allow refined diagnosis of connective tissue diseases now probably underestimated in African children.

Orthopedic aspects of musculoskeletal disease in children.

New information affecting the diagnosis and treatment of a wide variety of musculoskeletal conditions in children was published within the past year. A new etiology for acquired torticollis as well as a test to distinguish ocular and muscular torticollis were described. Familial predisposition for successful nonoperative treatment of interventional disk herniation was reported. Bone scintigraphy was shown to be helpful in defining the cause of occult gait disturbances, and accurate mapping of premature growth plate closure may soon be possible with magnetic resonance scans.