Hip pain in children

Introduction Children with growth pain are mainly children in the growing season, and boys are more common. The pain site is common in the knee joint, hip joint, and the like. This situation is a normal physiological phenomenon that occurs during the growth and development of children. Pain in the knee joint is the most common in the clinic, but many diseases can cause knee pain. Because the growth of children's bones is relatively fast, the periosteum and local muscle growth and development are not coordinated, causing discomfort and joint pain. It has also been suggested that this pain is caused by a low toxicity infection.

Cause

1. Periarticular ligament injury The knee joint ligament has relatively poor stability when the knee joint is slightly flexed. If the external force suddenly causes valgus or varus, it may cause damage to the medial or lateral collateral ligament. The patient has a clear history of trauma, knee pain, swelling, ecchymosis, and limited mobility.

2. Cartilage damage is mainly the meniscus injury of the knee joint. When the knee joint is slightly flexed, if the knee is suddenly over-extended or knee-extended, such as kicking a soccer ball, the movement of bending the calf and kicking the ball, there is May cause a meniscus tear. Meniscus injury has a significant knee tear, followed by joint pain, limited mobility, walking claudication, and joint movements.

3. Joint synovitis Due to trauma or excessive strain and other factors, a large amount of fluid will be produced after the joint synovial membrane is damaged, which will increase the pressure in the joint, causing joint pain, swelling, tenderness, and the sound of rubbing and bun. For example, when the knee joint is extremely stretched, especially when there is a certain resistance to knee extension exercise, the pain in the lower part of the tibia will be aggravated. In the case of passive extreme flexion, the pain is also significantly increased.

4. Autoimmune diseases Diseases Immune system diseases such as lupus erythematosus and psoriasis can also invade the joints, which depends on blood tests to assist in diagnosis.

5. Child growth pain These patients are mainly children in the growing period, and boys are more common. The pain site is common in the knee joint, hip joint, and the like. This situation is a normal physiological phenomenon that occurs during the growth and development of children. Because the growth of children's bones is relatively fast, the periosteum and local muscle growth and development are not coordinated, causing discomfort and joint pain. It has also been suggested that this pain is caused by a low toxicity infection.

6. Traumatic joint pain due to an accident or accident, the joints of the shoulders, wrists, knees, ankles and other parts of the joints in the absence of fractures and other serious trauma (such as soft tissue injury, fracture dislocation, etc.) and joint pain.

7. Septic arthritis has a history of infection of other parts of the body or a history of local trauma. The painful joints may be swollen, and the parts may not be obvious, but there are elevated body temperature, joint pain, inactivity, elevated blood levels, etc. phenomenon.

8. The age of onset of osteoarthritis osteoarthritis is mostly after 40 years of age. Joint pain is heavier in the morning and lighter during the day and night. Bone hyperplasia at the joint site and spur rubbing around the tissue can cause joint pain.

9. Osteoporosis Older women have multiple joint pains and feel particularly weak. They can't walk with heavy weight. If other diseases are excluded, they may have osteoporosis.

10. Rheumatoid arthritis and rheumatoid arthritis occur mostly in women between the ages of 20 and 45. Rheumatoid arthritis is often a migratory pain (the position of pain is uncertain). Pain, swelling, and stiffness often occur in the wrist, and the sensitivity and swelling of the joints occur simultaneously. Symptoms (such as wrists and knees) ).

11. Gouty arthritis Gout pain is common in the thumb and the first metatarsophalangeal joint (outside of the thumb). Mainly due to the consumption of seafood and drinking, which is induced by metabolic disorders in the body. In the acute phase, the patient is locally swollen and painful and unbearable; in the chronic phase, the patient may have pain, joint deformation and the like.

12. Pain caused by strain due to the relatively large amount of activity in the joints, resulting in muscle strains such as muscles around the joints, and then cause pain, common with frozen shoulder, tennis elbow and so on.

13. Tumor-induced pain Localized tumors in joints are also an important factor in joint pain, which is more common in children and the elderly during growth and development. If there is swelling and pain in the joints, the pain is more severe in the evening than in the daytime. If the painkilling drug is invalid, there is no reasonable reason to explain it. You should go to the hospital for further examination to rule out the joint tumor.

an examination

Related inspection

Rheumatoid factor antinuclear antibody (ANA)

Joint pain should be comprehensive and detailed physical examination. First of all, it should be a diagnosis, to observe whether the joints are red, swollen, venous anger, sinus, epilepsy, muscle atrophy, deformity and so on. Combined with palpation, whether the sides are symmetrical, equal length, and whether there is joint effusion. For example, the floating sputum test of the knee joint is a common method for checking joint effusion. Gait is often also an important manifestation of joint disorders, such as breaking, duck gait, jumping gait, sluggish and paralytic gait, squatting gait, etc. Some joint lesions can be bounced when joints move. The palpation of the joint is an examination of the muscle contraction and joint mobility around the joint, and the two sides are compared. Limb measurement is also part of the diagnosis. There are different special examination methods for different joints, and different examination methods have special significance for the diagnosis of diseases.

1. Antinuclear antibody (ANA)

It refers to antibodies against various nuclear components and is a widely existing autoantibody.

2, rheumatoid factor (RF)

Rheumatoid factor is an autoantibody against human denatured immunoglobulin that appears in the serum of patients with rheumatoid arthritis and other diseases.

3. Serum globulin (G, GL0)

Serum globulin is a mixture of various proteins, including immunoglobulin veneers and complements, a variety of glycoproteins, metal-binding proteins, various lipoproteins, and enzymes. The content of globulin is generally obtained by subtracting albumin from total protein.

4. Alanine aminotransferase (ALT)

Formerly known as alanine aminotransferase (GPT). ALT is contained in tissues and organs such as liver, kidney, heart and muscle.

5. Lactate dehydrogenase (LDH, LD)

Lactate dehydrogenase is a glycolytic enzyme. Lactate dehydrogenase is present in the cytoplasm of all tissue cells in the body, with a high kidney content.

6, skeletal muscle autoantibodies (ASA)

A method of examination for myasthenia gravis.

7, circulating immune complex (CIC)

The substance formed by the combination of the antigen and the corresponding antibody is called an immune complex. The immune complex is combined with complement and other immunoactive substances and deposited on the blood vessel wall, which can cause tissue damage and vasculitis, causing a series of diseases such as lupus erythematosus. Immune complexes can be detected in circulating blood, so they are called circulating immune complexes.

Although the measurement of circulating immune complexes has no specific diagnostic significance, it has certain value for the activity judgment and guiding treatment of the disease. There are many methods for measuring circulating immune complexes. Only the commonly used polyethylene glycol method is introduced here.

The circulating immune complex interacts with polyethylene glycol and exhibits turbidity changes, which can reflect the amount of immune complexes according to the size of the turbidity. If the turbidity is large, it indicates that the circulating immune complexes in the blood increase and the disease activity, but there is no specific value for the diagnosis.

8, anti-mitochondrial antibody (AMA)

Refers to an antibody against the mitochondrial inner membrane lipoprotein component, without organ and species specificity.

9, urinary iron (Fe)

Urine check.

10, urinary myoglobin (UMb)

In normal people, there is very little myoglobin in the urine. When muscle tissue damage and metabolic disorders are caused by various reasons, a large amount of myoglobin is produced. Due to the small molecular weight of myoglobin, it is easy to be filtered by the renal tubule to cause myoglobinuria.

11, plasma viscosity (PV)

Plasma viscosity is about 1/8 to 1/4 of the viscosity of whole blood, which is one of the indicators reflecting blood fluidity. Generally, plasma viscosity is mainly related to changes in the molecular compound, such as fibrinogen, globulin, blood lipids and sugars. Increased plasma viscosity leads to poor blood flow and even blockage, which can reflect the presence of congestion.

Differential diagnosis

First, knee pain

Pain in the knee joint is the most common in the clinic, but a variety of diseases can cause knee pain. Because of different causes, the treatment methods used are different. Therefore, accurate diagnosis is the primary prerequisite for treatment.

1. Various knee pain caused by arthritis.

2. Intra-articular injuries and lesions.

1) Meniscus injury: There is a history of trauma, joint pain may have tender points, pain disappears after rest, Me, Murray sign positive, may have joint interlocking.

2) Cruciate ligament injury: more traumatic history, unstable joints, positive drawer test.

3) Cartilage damage: fractures or cartilage can occur after articular cartilage injury.

4) Joint free rest: joints appear interlocking phenomenon, pain disappears after rest X-ray can be diagnosed or arthroscopy can also be diagnosed.

5) humeral cartilage softening: young adults are prone to occur, pain in the knee before standing, standing pain, up and down stairs pain, positive pressure test.

6) Lip injury: There is a meniscus-like fibrous cartilage lip around the joint of the shoulder bone. The injury or tear after abduction can also cause shoulder pain. Diagnosis by arthroscopy and surgery under arthroscopy.

7) refers to the fat pad inflammation: more common obese women, standing, walking can be pain, tenderness at the fat pad.

3, synovial lesions

1) Synovial osteochondroma disease: This disease is a chronic disease of the joint synovium, mainly involving the paint joint. This is a synovial tissue transformed into cartilage tissue, forming multiple chondromas, separating and detaching, freeing the joints, and forming osteochondral nodules after ossification.

2) pigmented villonous nodular synovitis: this disease joint puncture is helpful for diagnosis, can extract dark brown plasma-like liquid, but in the end often rely on synovial tissue pathology to confirm the diagnosis.

3) Localized nodular synovitis: This disease generally invades the knee joint. Unlike the villus type, there is little villus or deep pigmentation, so it is named as local nodular synovitis, knee joint. Pain, limited movement, joints can be interlocked, and mobile nodes of varying sizes can be accessed.

4) Tumor at the joint site: The tumor at the joint site can express joint pain and the distal part of the femur and the proximal end of the embryo are the high-incidence sites of the bone tumor. Commonly there are giant cell tumor of bone, chondroblastoma, cartilage fluid fibroma, aneurysmal bone cyst, synovial sarcoma, osteosarcoma and so on. X-ray and CT can assist in diagnosis.

Second, marrow pain

1, femoral neck fractures This disease is quite common, the most 50-70 years old. Incomplete fractures and non-displaced fractures and displaced fractures can be divided. The former has only pain in the pith after the fracture, and can still walk or ride a bicycle. The latter has flexion and external rotation and bone friction. The posterior superior dislocation of the pith joint has typical flexion, adduction and internal rotation deformity, and cannot be externally rotated. Both should be differentially diagnosed. History of trauma and X-ray film can be diagnosed.

2, femoral head bone marrow slip and trauma can lead to bone marrow displacement, spontaneous bone marrow slip can be secondary to sepsis, renal rickets, achondroplasia and multiple bone marrow dysplasia.

Spontaneous femoral head bone marrow is less common.

Hip pain, joint movement disorder X-ray film can confirm the disease.

3, rheumatoid arthritis

The disease is a systemic disease that can occur at any age. Early joints have morning stiffness and then gradually myalgia. Laboratory tests and X-ray examinations assist in diagnosis.

4, ankylosing spondylitis This disease is a chronic progressive inflammation of the spine, invading the sacroiliac joints, joints and large joints of the nearby ligaments and trunk cause fibrosis, bony rigidity and deformity, lower back pain and toughness; thoracic pain And stiffness, limited lumbar motion; chest expansion, history of iritis can be used as a diagnostic criteria. The HLA-B27X line filmer T can assist in diagnosis.

5, suppurative myelitis This disease is an acute severe joint infection. It occurs mostly in children and young children. Because the parts of the myeloid joint are deep and the surrounding muscles are thick, it is easy to delay the diagnosis and affect the treatment, resulting in joint rigidity, loss of function and disability.

6, hip joint tuberculosis is generally occult, the early symptoms are puncture pain, gradually worsening, may have symptoms of tuberculosis poisoning. X-ray examination is extremely important for the early diagnosis of this disease.

7, temporary periostitis This disease is a self-healing non-specific inflammation. It is characterized by the disappearance of pain symptoms within a few weeks and sustained recovery. There were no obvious abnormalities in the laboratory tests. The x-ray showed a swelling of the medullary capsule, a flat shadow of the gluteus medius, an arc shadow, and a widening of the joint space.

8, avascular necrosis of the femoral head due to bone ischemia caused by osteonecrosis, has become one of the common diseases in the development of modern medicine. A variety of causes can cause avascular necrosis of the femoral head, the common symptoms are puncture pain, showing dull dull pain, and clinical symptoms such as breaking. X-ray film, CT, MRI is a common method for diagnosing this disease.

9, enough joint osteoarthritis This disease can be divided into primary and secondary, pathological changes from cartilage changes, subchondral bone lesions. The clinical symptoms are characterized by slow onset, and the severity of soreness is not directly proportional to the performance of the X-ray. Severe patients may have joint stiffness and break. The pain of this disease begins to be the most obvious when sitting and standing. After the activity, the joints are flexible and the soreness is gradually reduced. However, excessive activity can cause soreness and limited movement.

10, voyage soft tissue disorders such as sciatic nerve pelvic outlet stenosis, piriformis syndrome, bursitis, gluteal muscle contracture, etc. can all cause pain in the pith joint, should be carefully identified.

11, medullary tumors and tumor-like lesions are more common are osteochondroma, chondroma, giant cell tumor of bone, bone cyst, aneurysmal bone cyst, poor bone fiber structure, synovial chondromatosis, osteosarcoma. Chondrosarcoma, osteofibrosarcoma, synovial sarcoma, metastases, etc. These lesions lead to different degrees of X-ray examination of the pneumonia to assist in the diagnosis, and biopsy can confirm the diagnosis.

12, pigmented villonodular synovitis, hemophilic arthritis, exfoliative osteochondritis and other diseases also often occur in the pith joint, also caused pain in the bowl.

Third, shoulder pain

1, shoulder soft tissue disease and injury

1) inflammation around the shoulder joint: the disease is seen in the elderly over 40 years old. Because 2/3 bones are in contact with the joint capsule, it is prone to adhesive joint capsule inflammation on the basis of senile degeneration, causing pain and dysfunction of the posterior joint. Suffering from shoulder pain all day long, especially at night. The shoulder activity is obviously limited, especially the external rotation is more prominent. Cerebral biceps tendonitis, tearing of the upper thigh, muscle, membranous inflammation, rheumatoid arthritis, etc. are often the cause of the disease. Extra-shoulder factors are often caused by cervical spondylosis, heart disease, and shoulder braking. X-ray can assist with diagnosis.

2) rotator cuff tear: more common in young adults, injury is the cause of the disease. More expression of shoulder and upper arm pain, under the shoulder, tenderness at the large nodules, partial tears may have pain arc performance, that is, the sacral joint active eve 00-600 range of tenderness, 600-120. Pain occurred within the range, and there were no signs of pain after more than 1200. When the person is completely torn, the shoulders cannot be outreached, and the outreach can be maintained after reaching out to 900.

3) Acromial sac bursitis: tenderness under the shoulder, there may be pain arc, more common in young adults, injury is the cause of this disease.

4) Tenosyrosal tenosynovitis: When the procaine is partially closed, the pain disappears, and the shoulder abduction can be lifted up 1800 and powerful; while the same muscle waist is broken, although the pain disappears after the seal, but the pain disappears, but The arm cannot be automatically abducted and lifted up to 1800 or abducted. If the lime-line online muscle vaginitis X-ray examination, there is calcium deposition at the large nodules.

5) biceps long-headed key chain sheath inflammation: more common in middle-aged and elderly, pain in the lateral side of the shoulder or upper arm, anti-bone biceps sulcus tenderness, partial limitation of shoulder activity. When the active elbow and forearm are rotated under resistance, the affected part is painful.

6) Lip injury: There is a meniscus-like fibrous cartilage lip around the joint of the shoulder bone. The injury or tear after abduction can also cause shoulder pain. Diagnosis by arthroscopy and surgery under arthroscopy.

2, shoulder arthritis shoulder arthritis has a variety of causes, according to medical history, clinical manifestations and laboratory tests can be identified. If the onset is more acute, the joints are swollen, severe pain, high fever and systemic infections, laboratory tests for white blood cells, neutrophils rise, and erythrocyte sedimentation rate. Joint puncture has a purulent fluid, which can be diagnosed as septic arthritis. The shoulder pain is lighter, the medical history is longer X-ray examination of bone destruction, pay attention to the posterior joint tuberculosis. The incidence of rheumatoid arthritis in the shoulder joint is different. It can be a local rheumatoid inflammatory manifestation of the shoulder joint or a shoulder lesion of rheumatoid systemic disease. Shoulder rheumatoid arthritis usually affects the bilateral shoulder joints, which are characterized by joint pain, swelling, morning stiffness and gluing. Rheumatoid factor is often positive.

Primary osteoarthritis is not common in the shoulder joint. Shoulder joint osteoarthritis is mostly caused by shoulder injury and long-term stress of the shoulder joint. Pain often worsens after a day of getting up and moving. After a night of rest, the morning did not ease. After a little activity, the symptoms turned light. After a day of work, the afternoon became worse. The joints are stiff, swollen and have limited range of motion. X-ray examination, narrow joint space, subchondral bone sclerosis and bone cystic changes, may have osteophytes.

In addition, gout, pseudogout, systemic lupus erythematosus, psoriatic arthritis, hemophilic arthritis, etc. can invade the shoulder joint, combined with physical signs and clinical features for differential diagnosis.

3. The incidence of tumors after and after the shoulder tumor is second only to the tumor around the knee joint. Benign bone tumors have no significant pain unless they are pressed against the skin or nerves or malignant. There are two primary and secondary malignant bone tumors. Most of the primary malignant bone tumors are single-shot, and the local pain is severe. Before the appearance of the tumor, it is intermittent, and it is persistent. The superficial superficial vein or capillary network can be dilated, the skin temperature is elevated, the tenderness is obvious, and even tremors or murmurs can be felt. Shoulder tumors include tumors that occur at the upper end of the brain, shoulder bones, and clavicle. The clavicle rarely has a tumor, and the patient has local pain because the clavicle is located under the skin. And the obvious block diagnosis is easier. If there is neurovascular symptoms in the clavicle area. The presence of lung tumors should be considered. The shoulder bone is a flat bone, which is surrounded by muscles. It is difficult to diagnose early. The shoulder and malignant tumors and giant cell tumors are painful and radiate to the arms and back.

Superficial tumors are easy to find, and deeper ones must be compared with the healthy side for detailed examination. More common shoulder swelling osteochondroma occurs in children, juveniles. The proximal end of the keel is osteosarcoma, the third most common site of giant cell tumor of the bone, chondrosarcoma, bone metastases are not uncommon. Tumor-like diseases are most common with bone cysts. Imaging X-ray film is the most important, it can suggest the benign and malignant tumors, and even make a clear diagnosis. CT, MRI, digital visualization angiography does not have the above advantages, but can clearly indicate the tumor range, blood supply is rich or not, and the relationship with adjacent tissues and organs, is conducive to surgical treatment. An increase in blood alkaline phosphatase can help diagnose osteosarcoma. Rapid blood sedimentation and increased urinary globulin in the blood may indicate the presence of myeloma. Although a preliminary diagnosis of bone tumors can be made through medical history, physical examination, laboratory and imaging examinations, the final diagnosis is still determined by histopathological examination.

Fourth, elbow pain

Shengjie is a joint with a large range of activities in the human body, which has a great effect on work and daily life. Elbow joint lesions often cause joint swelling and pain. Elbow joint joint swelling, pain without redness and joint mobility limitation are more common in the elbow joint synovitis, elbow joint scalpel tip cystic mass, mild or painless, common in ulnar olecranon bursitis, Mostly caused by trauma or chronic irritation, elbow joint swelling, joint friction, often accompanied by pain, mostly caused by proliferative osteoarthritis, elbow joint swelling, joints sometimes due to interlocking activities, X-ray examination There are several joint free bodies, which may be exfoliative osteochondritis of the joints. Progressive swelling of the elbow joint, increased pain during activity. Most people with bone destruction on the J-ray examination are tuberculosis of the elbow. If the joint is swollen and accompanied by redness, swelling, heat and pain, septic arthritis should be considered. Certain systemic diseases can also cause swelling of the elbow joints, such as rheumatism, rheumatoid arthritis, hemophilic arthritis, psoriatic arthritis, gout, and the like. Joint swelling and pain, nocturnal pain is more obvious J-ray examination of bone destruction can consider the possibility of tumor, if necessary, biopsy. Extracranial epicondylitis is one of the most common conditions of elbow pain. In addition to the prevention of bone, the disease has a limited point of tenderness. When the fist is bent and the forearm is extended, the pain in the affected part is aggravated. The incidence of epicondylitis in the brain is much less than that of the upper epicondylitis. When the forearm is used against the pronation, it can cause pain in the upper part of the limb bone. When the force is extended and the wrist is extended, the forearm can also cause pain. Both can be recurrent due to overwork.

Five, wrist and hand pain

There are many causes of pain in the wrist and hand, each with its own characteristics.

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