Musculoskeletal Disorders In Children Research Articles

Conventional Radiography Assessment of the Pediatric Knee: Pearls and Pitfalls.

Knee pain is one of the most common indications for radiography in the evaluation of musculoskeletal disorders in children and adolescents. According to international guidelines, knee radiographs should be obtained when there is the suspicion of an effusion, limited motion, pain to palpation, inability to bear weight, mechanical symptoms (such as "locking"), and persistent knee pain after therapy. When indicated, radiographs can provide crucial information for the clinical decision-making process. Because of the developmental changes occurring in the knee during growth, the assessment of knee radiographs can be challenging in children and adolescents. Radiologists unfamiliar with the appearance of the knee on radiographs during skeletal maturation risk overcalling or overlooking bone lesions. Image acquisition techniques and parameters should be adapted to children. This article describes the most common challenges in distinguishing pathology from the normal appearance of knee radiographs in the pediatric population, offering some pearls and pitfalls that can be useful in clinical practice.

The mediation effect of vitamin A and vitamin D supplement in the association between serum vitamin K levels and musculoskeletal disorders in preschool children.

Vitamin K deficiency may elevate the incidence of musculoskeletal disorders (MSD), whereas it lacks validation for pediatric populations and has uncertain dose recommendations. In this context, we hypothesized that serum vitamin K levels are associated with MSD in preschool children, and the widely used vitamin A and vitamin D supplements may mediate these associations based on potential mechanisms, which expects to provide guidance for future practice. A cross-sectional study was conducted in Sichuan province in southwestern China, from January 2021 to May 2022. Serum levels of vitamin K1/K2 and 25(OH)D were determined using the high-performance liquid chromatography method, and the diagnosis of MSD was executed by clinicians. Overall and stratified logistic regression analysis based on categorized 25(OH)D levels were conducted to assess association between serum vitamin K levels and MSD prevalence after adjusting for confounders. Mediation analysis was further performed and vitamin A and D supplementation was regressed as the mediator. A total of 6,368 children aged 0-6 years old were enrolled. MSD was identified in 1179 (18.51%) of the children, while 5,189 (81.49%) of them did not present such disorder. After adjusting confounders, a significant difference was found in serum vitamin K1 level between children in MSD and Non-MSD group (OR = 0.802, 95%CI 0.745-0.864). No significant difference was found in serum vitamin K2 level between the two groups (OR = 0.975, 95%CI 0.753-1.261). The association between vitamin K1 level and MSD prevalence was partly (36.8%) mediated by vitamin A and D supplementation. A low serum vitamin K1 level is connected with an increased risk of MSD among children, highlighting that vitamin A and D supplementation is a helpful intervention to prevent MSD in children with vitamin K deficiency.

Ankle and Foot Deformities in Children.

Ankle and foot deformity is one of the most common musculoskeletal disorders in children and a leading cause of functional impairment and diminished quality of life when not treated. A spectrum of conditions may produce foot and ankle deformities, with congenital disorders the most frequent cause, followed by acquired conditions. Congenital disorders include congenital talipes equinovarus or congenital clubfoot, metatarsus adductus, skewfoot, congenital vertical talus, and tarsal coalition.Some of these deformities are frequent and easily diagnosed based on clinical features, but clinical overlap between pathologies can be challenging. Thus imaging plays a paramount role in evaluating these patients. Radiographs are the first imaging modality of choice, but they may not be sufficient in infants due to the lack of ossification of the tarsal bones. Ultrasonography allows not only a detailed visualization of the cartilaginous structures but also permits a dynamic study of the foot and ankle. Computed tomography may be necessary in certain conditions such as tarsal coalitions.

Risk Factors in Musculoskeletal Disorder Development in Children Connected With the Extended use of Information and Communication Technologies

Introduction: The way of life in modern society goes along with new technological discoveries and achievements. This lifestyle leaves its positive and negative consequences on children. Such changes are especially reflected on health already in earliest stages of life. The studies show that most children have been using computers even since kindergarten and that children’s computer use is longer than recommended. It is more effective and cheaper to prevent musculoskeletal disorders than to cure them. Goal: To examine all risk factors concerning the development of musculoskeletal disorders connected with a long use of information and communication technologies by reviewing scientific literature. Material and methods: Non-experimental qualitative research into the risk factors of the development of musculoskeletal disorders connected with a long use of information and communication technologies based on relevant databases. Results and discussion: Based on a discussion of the attitudes and opinions of other authors, risk factors are divided in three basic groups: ergonomic, individual, and psychosocial risk factors. As it is shown in the discussion of this paper, a disbalance of the desk for a desktop computer, the non-ergonomic design of the furniture, the type and time of the ICT usage device, the sedentary way of using the ICT devices at school and at home are just some of the numerous risk factors to children’s health. Conclusion: By examining the risk factors in the development of musculoskeletal disorders in children connected with an extended use of information and communication technologies, the presented evidence in the discussion section based on other authors’ attitudes and opinions, leads us to the conclusion that numerous risk factors that affect children’s health are due to a larger and more frequent use of computers, console games, tablets and mobile phones.

Periodontal Diseases and Dental Caries in Children With Cerebral Palsy

Objectives: Musculoskeletal disorders in children with Cerebral Palsy (CP) affect the general health of the mouth and teeth. This study aimed to determine periodontal and dental diseases in children with CP based on gross motor function level, manual ability level, and subtypes of CP. Methods: This research was a cross-sectional study performed on 123 children (3-18 years old) with CP referred to dentistry and rehabilitation centers supervised by Tehran University of Medical Sciences in 2019-2020. They were selected by the convenience sampling method. The children were classified according to the gross motor function classification system: expanded and revised (GMFCS-E&R) for their gross motor function level, according to the manual ability function classification system (MACS) and mini-MACS for the functioning of their hands in handling objects, and according to the quality and topographical pattern of motor impairment for subtypes of CP. The periodontal status of children with CP was evaluated according to the recommendation of the World Health Organization using the community periodontal index and for caries according to the decayed, missing, filled index. All statistical analyses were done by SPSS v. 16. Results: The results showed significant differences between periodontal disease and sex, age, GMFCS-E&R, MACS, mini-MACS levels, and subtypes of CP (P<0.05). But there were no significant differences between teeth diseases and oral motor skills with sex, age, MACS and mini-MACS, GMFCS-E&R levels, and subtypes of CP (P>0.05). Discussion: Periodontal disease and decayed, missing, filled teeth are common problems in CP children, and the conditions worsen with age and level IV and V of GMFCS-E&R and MACS.

Epidemiological determinants of children's orthopedic care in rural central India

Background: Musculoskeletal disorders of children in rural India are often highlighted through anecdotal reports of delayed presentations. This study was conducted to identify prevalence and factors that influenced children's orthopedic care in a secondary hospital in rural Central India. Methodology: A retrospective survey was conducted to identify the prevalence of musculoskeletal disorders and delayed presentation among children at our institution from July 2011 to June 2016. Actionable epidemiological determinants were identified with the Delphi method and a prospective cohort was analyzed for delayed presentation. Results: Among 2281 children 71% presented with trauma. The incidence of delayed presentation among the trauma cases was 28%. Remaining had neuromuscular (17%), infectious (3.75%), metabolic (1.5%), congenital (3.25%), and miscellaneous (3.5%) disorders. Delayed presentation in 19 children from a prospective cohort of 100 patients showed significant association with distance traveled to reach the clinic and poor transport infrastructure in rural areas (P = 0.025) but did not differ by socioeconomic scale (SES) (P = 0.085), lack of health insurance coverage (P = 0.348) or primary indigenous treatment (P = 0.535). In this cohort, 84% belonged to middle and low-SES families, 33% had insurance coverage, 79% received primary traditional remedies and 68% traveled from distant rural locations. Conclusions: Trauma care and neuromuscular diseases constituted the bulk of musculoskeletal disorders in children in this survey from rural India. Poor transport infrastructure led to delayed presentation in the prospective cohort but lower SES, lack of health insurance, and rampant primary indigenous treatment in rural areas are likely contributory factors.

CHILD INJURIES AND SPECIALIZED CARE FOR CHILDREN IN A CITY (for Saint Petersburg)

Introduction.Based on the state statistics and in-house research the rates of child injury in SaintPetersburg in 2015–2017 were examined. As compared with the previous years, the rates of injury prevalence in children of 0–14 years (145.2%) and adolescents of 15–17 years (247.5%) don’t tend to the decrease and exceed the overall rates for Russia.Materials and methods.The structure of child injury by gender, age, type of injury, injury localization, and number of bone fractures in various locations as per chapter XIX of ICD-10 were presented.Results and discussion.External causes include road accidents, physical assault (chapter XX of ICD-10). Low disability index associated with musculoskeletal disorders in children is an advantage (0.7 per 10 thousand). The activity of outpatient and inpatient medical facilities providing specialized aid to children with musculoskeletal diseases in Saint-Petersburg was analyzed. The unique research centers for treatment of severe injuries of the musculoskeletal system and their consequences in children located in the municipal and federal institutions of Saint-Petersburg were presented.

Whole-Body Diffusion-Weighted Imaging in Chronic Recurrent Multifocal Osteomyelitis in Children.

ObjectiveChronic recurrent multifocal osteomyelitis/ chronic non-bacterial osteomyelitis (CRMO/ CNO) is a rare auto-inflammatory disease and typically manifests in terms of musculoskeletal pain. Because of a high frequency of musculoskeletal disorders in children/ adolescents, it can be quite challenging to distinguish CRMO/ CNO from nonspecific musculosketetal pain or from malignancies. The purpose of this study was to evaluate the visibility of CRMO lesions in a whole-body diffusion-weighted imaging (WB-DWI) technique and its potential clinical value to better characterize MR-visible lesions.Material and MethodsWhole-body imaging at 3T was performed in 16 patients (average: 13 years) with confirmed CRMO. The protocol included 2D Short Tau Inversion Recovery (STIR) imaging in coronal and axial orientation as well as diffusion-weighted imaging in axial orientation. Visibility of lesions in DWI and STIR was evaluated by two readers in consensus. The apparent diffusion coefficient (ADC) was measured for every lesion and corresponding reference locations.ResultsA total of 33 lesions (on average 2 per patient) visible in STIR and DWI images (b = 800 s/mm2 and ADC maps) were included, predominantly located in the long bones. With a mean value of 1283 mm2/s in lesions, the ADC was significantly higher than in corresponding reference regions (782 mm2/s). By calculating the ratio (lesion to reference), 82% of all lesions showed a relative signal increase of 10% or higher and 76% (25 lesions) showed a signal increase of more than 15%. The median relative signal increase was 69%.ConclusionThis study shows that WB-DWI can be reliably performed in children at 3T and predominantly, the ADC values were substantially elevated in CRMO lesions. WB-DWI in conjunction with clinical data is seen as a promising technique to distinguish benign inflammatory processes (in terms of increased ADC values) from particular malignancies.

Differences in body posture, strength and flexibility in schoolchildren with overweight and obesity: A quasi-experimental study

BackgroundBody posture and its components have been widely discussed, given the high prevalence of musculoskeletal disorders in children and adolescents. Among children and adolescents with overweight and obesity issues, these changes can be pronounced. ObjectivesThis study sought to investigate whether a global exercise routine could result in positive changes in the angles and distances measured in postural assessments and in the number of abdominal and flexibility exercise repetitions performed by children and adolescents with overweight or obesity. MethodsA quasi-experimental design including an experimental group (EG) and a control group (CG) was used. The primary outcome variables included ratings of body posture (using SAPO software) and measures of abdominal muscle strength (number of sit-ups) and flexibility. The EG received an interdisciplinary intervention the included 48 sessions of global postural exercises performed three times a week. ResultsOf the 46 schoolchildren evaluated (EG, n = 23 and CG, n = 23), significant changes were observed in the EG from pre-to post-test in the thoracic angle (p = 0.001) and abdominal muscle strength (p = 0.016) for boys and in the thoracic angle (p = 0.010), abdominal muscle strength (p = 0.003) and flexibility (p = 0.010) for girls. ConclusionsOverall, the exercise program led to changes in the angle and distance measurements obtained in postural evaluations and contributed to increases in the number of repetitions of abdominal and flexibility exercises, indicating improvements in the EG group's body posture and health indicators.

Musculoskeletal anomalies in a national cohort of children and adolescents with trisomy 21

Musculoskeletal complications of Down syndrome are common. Joint laxity, which may be associated with delayed ambulation, is almost universal. The combination of this ligamentous laxity and low muscle tone contribute to an increased risk of a number of musculoskeletal disorders in children with Down syndrome.

The use of ultrasonography (US) in non traumatic musculo-skeletal disorders in infants and children

Ultrasongraphy (US) is a powerful diagnostic imaging tool for evaluating musculo-skeletal disorders in children. US is relatively cheap, non invasive and does not require sedation thus it is generally well-tolerated. Lack of ionizing radiation and dynamic imaging capabilities are significant advantages compared to CT and MRI too. US is ideally suited to the evaluation of the bone, cartilage and soft-tissue structures, including tendons and ligaments, joints and muscles [1]. The combined use of new generation high frequency transducers and of Power Doppler increases the diagnostic accuracy of US. US is widely used in the diagnosis of hip disorders in children [2]. In developmental displasia, it is essential for establishing an early diagnosis in order to allow a prompt treatment. In transient synovitis and hip infections US is able to demonstrate joint effusion, synovial thickening and cartilage damage. In Perthes disease US is a reliable technique to identify hip effusion, femoral head cartilage thickening as well as irregular, fragmented and flattened femoral epiphysis. In epiphysiolysis US allows the assessment of the severity of epiphyseal slipping by measuring the width of the physeal step [1]. Besides hip’s disorders, US can be employed in many other pathological conditions of the pediatric musculoskeletal system, including congenital, infectious, neoplastic and inflammatory disorders [3]. Particularly, in juvenile idiopathic arthritis (JIA) US is crucial for the diagnosis of the disease, the assessment of its severity and prognosis, the monitoring of disease progression and treatment response and the evaluation of complications related to the disease or its therapy. The US assessment of disease activity has been proven to be more informative than clinical examination. Moreover, multiple locations can be assessed during the same ultrasonographic session. US can guide intra-articular steroid injections for therapeutic purposes too. In acute osteomyelitis US is able to identify early abnormalities in the soft tissues overlying the bone just few days after the onset of symptoms before the appearance of radiographic signs. As infection progresses, US can depict interruption of the cortical profile related to bone destruction and diffuse involvement of subcutaneous tissue with formation of abscesses. Due to the peculiarities of the growing skeleton, the knowledge of musculoskeletal pediatric anatomy and especially of growth-related changes in healthy children is extremely important in establishing whether the US findings reflect pathology or are part of normal development [4].

Musculoskeletal ultrasound in childhood

Ultrasonography is one of the first line imaging modalities for the evaluation of musculoskeletal disorders in children. This article provides an overview of the most important pathologic entities in which ultrasonography significantly contributes to the diagnostic workup.

Magnitude of impact and healthcare use for musculoskeletal disorders in the paediaric: a population-based study

BackgroundAlthough musculoskeletal disorders (MSD) are among the most prevalent chronic conditions, minimal attention has been paid to the paediatric population. The aim of this study is to describe the annual prevalence of healthcare contacts for MSD by children and youth age 0-19 years, including type of MSD, care delivery setting and the specialty of the physician consulted.MethodsAnalysis of data on all children with healthcare contacts for MSD in Ontario, Canada using data from universal health insurance databases on ambulatory physician and emergency department (ED) visits, same-day outpatient surgery, and in-patient admissions for the fiscal year 2006/07. The proportion of children and youth seeing different physician specialties was calculated for each physician and condition grouping. Census data for the 2006 Ontario population was used to calculate person visit rates.Results122.1 per 1,000 children and youth made visits for MSD. The majority visited for injury and related conditions (63.2 per 1,000), followed by unspecified MSD complaints (33.0 per 1,000), arthritis and related conditions (27.7 per 1,000), bone and spinal conditions (14.2 per 1,000), and congenital anomalies (3 per 1,000). Injury was the most common reason for ED visits and in-patient admissions, and arthritis and related conditions for day-surgery. The majority of children presented to primary care physicians (74.4%), surgeons (22.3%), and paediatricians (10.1%). Paediatricians were more likely to see younger children and those with congenital anomalies or arthritis and related conditions.ConclusionOne in eight children and youth make physician visits for MSD in a year, suggesting that the prevalence of MSD in children may have been previously underestimated. Although most children may have self-limiting conditions, it is unknown to what extent these may deter involvement in physical activity, or be indicators of serious and potentially life-threatening conditions. Given deficiencies in medical education, particularly of primary care physicians and paediatricians, it is important that training programs devote an appropriate amount of time to paediatric MSD.

Paediatric musculoskeletal US beyond the hip joint

US is a technique particularly suited to the investigation of musculoskeletal disorders in children and adolescents. This review paper describes a range of clinical settings beyond the hip joint where US has a significant role to play, including sports injuries, infectious diseases, inflammatory and degenerative conditions, congenital and developmental disorders, acute trauma of bone and joints, and peripheral nerve injuries. In some circumstances, US can be regarded as the most effective means of diagnostic imaging, whereas in other instances, it is an alternative or supplement to other more comprehensive imaging modalities, like MRI and CT. Although MRI offers superior soft-tissue contrast resolution, US is low-cost, non-invasive and has higher spatial resolution and real-time capability for the assessment of musculoskeletal structures during joint movement and stress manoeuvres.

The Current Medical Practice of the Pediatric Orthopaedic Surgeon in North America

Musculoskeletal disorders in children are common and comprise 20% to 30% of the complaints observed by primary care physicians. Most primary care physicians prefer to refer patients with pediatric musculoskeletal conditions to the pediatric orthopaedic surgeon; most of whom are treated nonoperatively. Pediatric orthopaedic surgeons are well trained to provide efficient, cost-effective, and definitive quality care. This article supports the supposition that pediatric orthopaedic surgeons are the primary care physicians for children with musculoskeletal disorders. This article focuses on the primary clinical responsibilities of the pediatric orthopaedic surgeon, describes the value of this practice, and contrasts their responsibilities from that of other orthopaedic subspecialties.

There appears to be no link between fluoroquinolone use and musculoskeletal disorders in children,

There appears to be no link between fluoroquinolone use and musculoskeletal disorders in children,

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.

Efectos adversos musculoesqueléticos por el uso de fluoroquinolonas en niños: un metaanálisis

Joint cartilage toxicity secondary to fluoroquinolone use has been observed in young animals. These early observations led to the contraindication of fluoroquinolones in children under 18 years. Nevertheless, quinolones may be the only option for oral treatment of infections caused by Pseudomonas aeruginosa. To evaluate by systematic review and meta-analysis the relation between fluoroquinolonas and musculoskeletal disorders in children. Data sources were Medline, Cochrane data base, and free-text search through Google and Yahoo. MESh terms were: quinolones and arthropathy-tendinopathy and children. Randomized clinical trials, cohorts and case-control studies with a primary outcome of arthropaty and/or tendinopathy were included. Each study was scored and classified for methodological key issues according to level of evidence. Data were extracted using a predetermined protocol. The search identified 277 studies of whom 8 were eligible for inclusion that included 23 166 patients. All except one failed to find a significant link between fluoroquinolones use and musculoskeletal disorders. The pooled odds ratio was 1.02 (CI 0.76-1.38). Our meta-analysis does not support musculoskeletal disorders as a result of fluoroquinolones use in children under 18 years. Thus, in selected, appropriate, and mandatory cases fluoroquinolones should not be contraindicated in children.

Paediatric ultrasound. II. Other applications.

This article focuses on small-parts US in children. The differential diagnosis of cystic neck masses primarily includes lymphangiomas, thyroglossal duct cysts and branchial cleft cysts. Solid masses may be represented from lymphadenopathies, cervical extensions of mediastinal thymus, fibromatosis colli, rhabdomyosarcomas and neuroblastomas. Salivary gland lesions are uncommon in children. Thyroid is best evaluated by US and nuclear scintigraphy. If US shows abnormal thyroid gland, the isotopic scan may be a good complementary method to confirm the diagnosis. Normal parathyroid glands are not visualised routinely by US because of their small size. Parathyroid adenomas are unusual in paediatrics. Ultrasound can be successfully used in the differential diagnosis of the painful scrotum especially with colour flow Doppler. The hallmark of ischaemia is a completely avascular testis. In the paediatric age group, the most common application of US to the musculoskeletal system is the evaluation of the infant hip in the first 6 months of life; however, the refinement of new transducers has further improved the ability of US equipment to evaluate a variety of other musculoskeletal disorders in children, involving tendons, muscles, nerves as well as soft tissue masses. Ultrasound can be a useful screening tool in newborns suspected of having closed spinal dysraphism.

Musculoskeletal disorders in children: a study in Dutch general practice

This study focuses on the occurrence of musculoskeletal disorders in children presented in general practice. Known epidemiological studies addressing musculoskeletal diseases in childhood are scarce and based on a low number of episodes. Prospective study of all patient contacts in general practice. A total number of 161 general practitioners participated, divided into four groups, registering during four consecutive three-month periods. All children younger than 15 years of age who visited their GP during the registration period. All diagnoses and working hypotheses concerning musculoskeletal disorders were selected. The total number of children in the study was 64,198. Disorders of the musculoskeletal system accounted for 3,699 (7.5%) of all 49,309 contacts and for 3,046 (7.5%) of all 40,340 episodes. Of the 3,046 episodes registered for ICPC-chapter L (musculoskeletal), 2,562 (84%) were new episodes, i.e. not presented to the GP before. Fifty-four percent of all new episodes were acute injuries. In 22% of the new episodes the general practitioner made a symptom diagnosis. Differences by age and sex were found for a limited number of diagnosis categories. Children present disorders of the musculoskeletal system less often than adults; they also present different disorders to their general practitioners. The majority of disorders presented by children are acute injuries, mostly sprains and strains.