Back and leg pain in a child

Back pain, especially when it first appears, is acute, and especially when it is growing, requires the closest attention and maximum responsibility of the doctor. The causes of back pain vary depending on age, which determines the doctor's tactics. The younger the child, the more likely it is that the back pain is not related to tension in the musculoskeletal system and is organic in nature.

Back pain can be divided into the following categories.

• Disorders associated with mechanical causes:
  • strained tendon or muscle;
  • herniated nucleus pulposus of the intervertebral disc;
  • apophysiolysis;
  • poor posture;
  • compression fracture of the vertebra.
• Growth related disorders:
  • spondylolysis, spondylolisthesis;
  • Scheuermann-Mau disease (osteochondropathy kyphosis).
• Inflammation and infections:
  • discitis and osteomyelitis of the vertebra;
  • intervertebral disc calcification;
  • rheumatic diseases (ankylosing spondylitis, reactive spondyloarthropathies);
  • sickle cell anemia and sickle cell pain crisis;
  • epidural abscess.
• Neoplastic process:
  • spine or spinal canal;
  • muscles.
• Psychogenic causes.

In most patients with back pain, the cause of the pain is unknown, and it almost always resolves without treatment. However, a medical history and physical examination are necessary to rule out a more serious condition.

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Causal factors and factors influencing back pain syndrome

Back pain in preschool age is extremely rare, it can appear already in primary school age along with abdominal pain and headache, the prevalence of which at this age is much higher. In adolescence, the frequency of occurrence and the spectrum of pain syndrome do not differ significantly from adults.

If you have back pain, you should pay attention to the following factors.

• Food: fast food, sweets, sweet drinks, coffee, smoking, alcohol.
• Injury.
• Asymmetry of the body.
• Tall stature (height exceeding the average age norms of a given population by two sigma deviations or more). Back pain is most often recorded in tall young men.
• Female gender.
• Excessive sports activity or focus on records.
• Sore throat, headaches, daytime fatigue.
• Depression. Low self-esteem. Increased internal anxiety about one's own health. Insufficient support for the child by parents.
• Back pain in parents.
• A particularly clear connection between back pain in children and parents is noted in polyalgic syndrome, i.e. with simultaneous complaints of headaches, sore throats, and stomach pains. The correlation increases with the number of complaints, and a significant connection has been found even when patients complain of pain occurring in only 2 areas.
• Emotional factors.
• Low emotional self-control in boys and girls. Excessively high emotional self-control in girls.
• The feeling of expectation of pain and immersion in its sensation are important. During experimental pain provocation by pressing with a cold object against the background of an anxious conversation, the pain was perceived by the subjects as strong. And, conversely, when attention was distracted - as weak. Pain tolerance in older boys is higher than in younger boys. Pain tolerance in girls occupies an intermediate position.
• Stress.
• Relationship difficulties.
• Sedentary lifestyle. Decreased physical activity.
• Watching TV for more than 2 hours a day is a risk factor for back pain.
• Decreased elasticity of the muscles of the upper body.
• Back pain is directly correlated with decreased endurance of the long back muscle to isometric load. The more enduring the muscle, the less likely it is to complain of back pain. The frequency of back pain is higher in girls than in boys. The taller the girl, the more likely it is to hurt.
• Decreased mobility of the lumbar spine in the sagittal plane.
• Low academic performance.
• Overweight (weak correlation). Significant correlation with a body mass index of over 25 kg/ ^m2.
• Postural imbalance in the sagittal plane (weak correlation).

When deciphering the joint syndrome, it is important to immediately distinguish acute monoarthritis, chronic monoarthritis, acute polyarthritis and chronic polyarthritis. Such gradation allows for targeted differential diagnostics.

The most common causes (up to 90%) of acute monoarthritis are: purulent infection, trauma and crystals (gout, pseudogout). However, systemic connective tissue lesions often debut with monoarthritis. Anamnestic information about the sudden or gradual onset of disorders, probable etiologic factors, familial variants of gout or urate kidney stones, elevated temperature or afebrile variants, the presence of parathyroidism allow us to conduct a 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 (assume osteoarthritis; if there is a poor response to treatment, arthroscopy is indicated); inflammatory (look for bacteria, crystals, immune inflammation).

Chronic monoarthritis may occur with effusion into the joint cavity. (It is necessary to perform a puncture. In case of inflammatory fluid, a viral infection, purulent flora, the presence of mycobacteria, fungi are assumed. In case of non-inflammatory fluid, look for crystals). In the absence of effusion, radiography is decisive for the diagnosis.

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

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Anamnesis

• Basic anamnesis.
• Pain characteristics including severity, type, onset and duration, previous treatments and limitations, exacerbating and relieving factors.
• History of injury.
• Sports and work history.
• Systemic symptoms: fever, malaise, inflammation of the iris, urethritis, arthritis.
• Family history (rheumatological diseases).
• Neurological symptoms.

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