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Chapter 3 Index
A. General
B. Skin
C.
Orthopedics
--Orthopedic Exam of
the Teenager: Idiopathic Scoliosis |
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Back Pain in Children and Teens
Robert Pendergrast, MD
Incidence: Uncommon in preteens; more common in 18-20 year
olds. In these age groups, most of the causes of back pain are self-limited
most often caused by trauma.
Signs and Symptoms: Most diagnoses can be made by history
and physical exam. However, there are some specific symptom associations
that are important to identify:
- Fever and back pain: must think about one of three
categories:
- Infectious: such as diskitis (dx best with MRI),
osteomyelitis (older children and teens), pyelonephritis, Potts disease
from tuberculosis
- Inflammatory: ankylosing spondylitis, collagen
vascular diseases
- Neoplastic: lymphoma, leukemia, Ewings sarcoma,
Hodgkins
- Neurological symptoms associated with back pain:
- Disc herniation: sciatic nerve pain, bowel or
bladder symptoms – refer immediately should these symptoms exist.
- Tethered cord: seen in school aged children
- Anatomic Abnormalities:
- Excessive lordotic curvature : may indicate:
i. Spondylolysis (stress fracture of the posterior arch of the spine
acquired through repetitive extension loading – plain X-Rays may be
normal so a scan may be necessary)
ii. Spondylolisthesis (forward slippage of one vertebral body on top
of the other – L5 on S1 resulting from bilateral spondylolysis; can be
seen as a sensation of a shelf at the base of lordotic curvature)
- Kyphosis: seen in Scheuermann’s disease (wedging
of vertebral bodies seen on X-Ray): predisposes to spondylolisthesis
because of the compensatory lumbar lordosis associated with kyphosis.
- Diurnal variations of the time when back pain
occurs:
- Nocturnal: if present must look for osteoid
osteoma or osteoblastoma
- Pain late in the day: look for Scheuermann’s
disease.
- Age of onset:
- If present in the first two years of life,
probably symptoms would be a refusal to walk, fever or toxicity.
- School age children: can be the only presenting
sing of a tethered cord; Also include diskitis – seen in children < 10
yrs of age in a child who has trouble standing up; tumors; epidural
abscess; pyelonephritis
- Adolescent: if present less than 3 weeks, probably
OK; if more than 3 weeks, might do x-rays to look for spondylolysis.
Management: Physical therapy very helpful if spondylolysis
or spondylolisthesis. Other treatment includes: RICE (rest, ice,
compression, elevation), anti-inflammatories, strengthen abdominal muscles.
Exercise by doing extensor exercises such as raising the torso and head off
the floor while lying prone. Stretch after warming the muscles.
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