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OBJECTIVES

Review and discuss etiologies of musculoskeletal


PODOPEDIATRICS pain in school-
school-age children
ORIENTATION Discuss the importance of taking a thorough history
and careful evaluation to obtain an accurate
diagnosis
Morris T. Haywood, D.P.M. Review probing questions and related areas to
June15, 2010 better understand the nature of the complaint (pain)
Review and discuss Rubinstein-
Rubinstein-Taybi Syndrome

Pediatric Survey Reveals Many Parents


Neglect Their Children’s Feet “My daughter has been complaining of leg
pain off and on for several months. For the
last three weeks, she has been worse.
“Only 25 percent of parents have taken their children She will stop playing, sit down, and hold
to a podiatrist for foot ailments.” her legs. I just assumed it was growing
APMA pains like I had at that age. It’s probably
nothing, but my grandfather was crippled
by arthritis, and my husband’s mother had
rheumatic fever as a child…”
a concerned parent

Musculoskeletal pain in school-


school-age children Common causes of musculoskeletal pain

Up to 15% experience occasional limb pain Infection


Almost 5% have pain that last at least three Neoplastic disease
months and interrupts normal activities Trauma
Between 5% and 10% of children have Hypermobility
psychosomatic illnesses Overuse syndromes
Psychosomatic musculoskeletal complaints Rheumatic diseases
account for over 10% of new patient referrals to
pediatric rheumatology centers
Cawkwell,, GD. Pursuing the source of musculoskeletal
Cawkwell
pain; Contemporary Pediatrics. 1994; Vol. 11, Feb: 72-
72-90.

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When is a careful evaluation warranted? A careful evaluation

Occurs frequently Thorough history and physical examination


Alters activity Laboratory tests
Objective findings Radiographs
Systemic symptoms
Psychologic issues

Understanding the nature of the complaint Importance of sleep habits


Is the major symptom pain or stiffness?
What is the nature of the pain? Pain can disrupt sleep, but sleep deprivation
What is the frequency and duration of the pain? also aggravates pain
Was the onset of symptoms acute or insidious? Inactivity increasingly hampers sleep and
Where is the pain located? causes a minor complaint to gradually worsen
Is the pain consistently located in one area or does it Nonrestorative sleep may also signal stressors
migrate?
that require more extensive evaluation and
Did trauma, infection, or recent activity precipitate or
treatment
increase the pain?
Does the affected area look or feel different?
What previous attempts have been made to diagnose or
treat the symptoms?

Factors that suggest a psychosocial


Growing pains
component
Pronounced between the ages of eight and
A high rate of school absences twelve
Deteriorating school performance Diagnosis usually arrived at by exclusion
Withdrawal from activities and friends Pain is usually nocturnal and has a vague
characteristic and location in the lower leg
Lack objective findings

Peterson H: Growing pains. Pediatr Clin North Am 33(6): 1365, 1986

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Rubinstein--Taybi Syndrome
Rubinstein Rubinstein--Taybi Syndrome
Rubinstein

FACTS Symptoms & Clinical Features

Broadening of the thumbs and big toes


A rare genetic disease Constipation
Abnormal CREB binding protein (CREBBP) Excess hair on body (hirsutism)
1 in 125,000 births Heart defects
Mentally Challenged
Seizures
Short stature
Slow development of cognitive skills
Slow development of motor skills

Rubinstein--Taybi Syndrome
Rubinstein

Symptoms & Clinical Features

An underdeveloped bone in the midface


Narrow palate
Crowded teeth
Unsteady or stiff walking gait
Downward-slanted eyes
Low-set ears
Drooping eyelid (ptosis)
Cataracts
Prominent or “beaked” nose
Absent or extra kidney

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….Any Questions?