Pain in the back and legs of a child

Back pain, especially arising for the first time, acute, especially growing, requires the most close attention and maximum responsibility of the doctor. The causes of back pain are different depending on age, which determines the tactics of the doctor. The younger the child, the more likely that the back pain is not related to the musculoskeletal system tension and is of an organic nature.

Back pain can be divided into the following categories.

• Disorders associated with mechanical causes:
  • stretching of the tendon or muscle;
  • a hernia of the pulpous nucleus of the intervertebral disc;
  • apophyseolysis;
  • violation of posture;
  • compression fracture of the vertebra.
• Growth related disorders:
  • spondylolysis, spondylolisthesis;
  • Sheyermann-Mau disease (osteochondropathy kyphosis).
• Inflammation and infection:
  • discitis and vertebrae osteomyelitis;
  • calcification of the intervertebral disc;
  • Rheumatic diseases (ankylosing spondylitis, reactive spondyloarthropathies);
  • sickle-cell anemia and sickle-cell pain;
  • epidural abscess.
• Neoplastic process:
  • spinal column or spinal canal;
  • muscle.
• Psychogenic causes.

In most patients with back pain, the cause of the pain is unknown, and it almost always goes away without treatment. However, in order to exclude a more serious condition, it is necessary to collect anamnesis and physical examination.

[1], [2], [3], [4]

Causal factors and factors affecting the syndrome of back pain

Back pain in preschool age is extremely rare, can occur already at the younger school age, along with abdominal pain and headache, the prevalence of which at that age is much higher. In adolescence, the frequency of occurrence and the range of pain syndrome are not significantly different from adults.

In the presence of pain in the back should pay attention to the following factors.

• Meals: fast food, sweets, sweet drinks, coffee, smoking, alcohol.
• Injury.
• Asymmetry of the trunk.
• High stature (growth exceeding the average age norms of this population by two sigma deviations and more). Most often, back pain is recorded in tall boys.
• Female.
• Excessive sports activity or focus on records.
• Sore throat, headache, daytime fatigue.
• Depression. Low self-esteem. Increased internal anxiety in relation to their own health. Insufficient support of the child by parents.
• Pain in the back of the parents.
• Especially distinct connection of back pain in children and parents is noted in polyalgic syndrome, i.e. With simultaneous complaints of headaches, sore throat, in the abdomen. Correlation increases with the number of complaints, and a significant connection is revealed even in patients' complaints of pain that arise only in 2 areas.
• Emotional factors.
• Low self-control of emotions in boys and girls. Excessive self-control of emotions in girls.
• The sense of expectation of pain and immersion in her sensation matters. With the experimental provocation of pains by the pressure of a cold object against a background of anxious conversation, the pain was perceived by the subjects as strong. And, on the contrary, when distracting attention - as a weak. Tolerance to pain in older boys is higher than in younger boys. Tolerance to pain in girls occupies an intermediate position.
• Stress.
• Difficulties in relationships.
• Passive lifestyle. Decreased physical activity.
• Watching TV more than 2 hours a day is a risk factor for back pain.
• Reduced elasticity of the musculature of the upper trunk.
• Back pain directly correlates with decreased endurance of the long back muscle to an isometric load. The harder the muscle, the less likely it is to complain of back pain. The incidence of back pain is higher in girls than in boys. The more a girl grows, the more likely the pain.
• Reduced mobility of the lumbar spine in the sagittal plane.
• Low school performance.
• Increased body weight (weak correlation). Reliable correlation with a body mass index of more than 25 kg / m ².
• Violation of posture in the sagittal plane (weak correlation).

When deciphering the joint syndrome, it is important to immediately isolate acute monoarthritis, chronic monoarthritis, acute polyarthritis and chronic polyarthritis. This graduation allows for a purposeful differential diagnosis.

The most common causes (up to 90%) of acute monoarthritis are: purulent infection, trauma and crystals (gout, pseudogout). However, systemic lesions of connective tissue are often debuted from monoarthritis. Anamnestic information about the sharp or gradual onset of disorders, probable etiologic factors, family variants of gout or urate kidney stones, fever or no fever, the presence of parathyroidism allow us to search in the right direction.

It is necessary to examine the synovial fluid and, if necessary, perform arthroscopy. Synovial fluid is divided into hemorrhagic (for differential diagnosis with trauma it is important to determine the number and functional capacity of platelets, bleeding time); non-inflammatory (suggest osteoarthritis, with poor response to treatment shows arthroscopy); inflammatory (to look for bacteria, crystals, immune inflammation).

Chronic monoarthritis can occur with an effusion into the joint cavity. (It is necessary to perform a puncture.) In case of an inflammatory fluid, a virus infection, a purulent flora, the presence of mycobacteria, fungi is presumed. In the absence of effusion the crucial for diagnosis is radiography.

Polyarthritis can be a manifestation of: reactive arthritis, rheumatism, Reiter syndrome, Lyme disease, gonococcal infection, psoriasis, ankylosing spondylitis, SLE, systemic vasculitis, sarcoidosis, colitis, rubella. Viral hepatitis, gout and pseudogout. (The last two states usually debut with monoarthritis.)

[5], [6], [7]

Anamnesis

• The main anamnesis.
• Characteristics of pain, including severity, type, onset and duration, prior treatment and limitations, enhancing and alleviating factors.
• History of trauma.
• Sports and working history.
• Systemic symptoms: fever, poor health, inflammation of the iris, urethritis, arthritis.
• Family history (rheumatological diseases).
• Neurological symptoms.

[8], [9], [10]