Hesperian Health Guides

Common Causes of Chronic Joint Pain in Children (Pain That Lasts More Than 2 Weeks or Keeps Coming Back)

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HealthWiki > Disabled Village Children > Chapter 15: Painful Joints > Common Causes of Chronic Joint Pain in Children (Pain That Lasts More Than 2 Weeks or Keeps Coming Back)


RHEUMATIC FEVER Age it often begins: 5 to 15 years old
Pain in one or in several joints Fever
Usually pain is in several joints. (Rarely it begins with severe pain and swelling in only one joint, but often there is also some pain in other joints.) Often pain starts in ankles and wrists, then knees and elbows. Pain may change from some joints to others. High fever is typical (usually starts suddenly).
DVC Ch15 Page 130-2.png
DVC Ch15 Page 130-1.png
Other signs Treatment and therapy
  • joint pain and fever usually begin 1-3 weeks after severe sore throat with fever (strep throat).
  • small lumps may appear under the skin over joints.
  • sometimes wiggly reddish circles on skin
  • in severe or advanced cases, heart problems (‘heart murmur’, difficulty breathing, or chest pain)
  • usually gets better in 6 weeks to 3 months—but likely to come back
  • pencillin V for 10 days each time throat gets sore (or continuosly if heart is affected)
  • aspirin or ibuprofen in high doses with precautions
  • rest
  • range-of-motion (ROM) exercises
  • apply heat or cold to painful joints.



JUVENILE ARTHRITIS Age it often begins: Any age, but often begins between 2-7 or 9-12 years old. Lasts for years (Often the arthritis gets better when child becomes sexually developed)
(also called juvenile rheumatoid arthritis or Still’s disease)
Pain in one or in several joints Fever
May affect few joints, many joints, or almost all joints.

(In ⅓ of children it begins in only one joint—later it may affect others.)
DVC Ch15 Page 130-3.png
Often some fever when pain is worst. (Rarely, it begins with high fever.)
DVC Ch15 Page 130-2.png
Other signs Treatment and therapy
  • usually no history of sore throat
  • severely painful, hot, swollen joints often leading to muscle weakness, contractures and deformities
  • sometimes a rash that comes and goes
  • may begin little by little, or suddenly and severely
    DVC Ch15 Page 130-5.png
  • one or both eyes may become red and sore (iritis) and become damaged
  • usually lasts for years with periods when it gets better and then worse
  • aspirin or ibuprofen in high doses with precautions to avoid stomach upset
  • apply heat or cold to painful joints
  • ROM exercises
  • exercises without motion to strengthen muscles
  • lots of rest, but also moderate activity
  • lots of understanding and support



DESTRUCTION OR SLIPPING OF CAP OF THIGH BONE AT THE HIP Age it often begins:

Destruction: mostly boys 4-8 years old

Slip: mostly boys 11-16 years old
Pain in one or in several joints Fever
Pain in one hip (rarely both)
Destruction: Cap of head of thigh bone breaks into pieces and gradually re-forms in 2 to 3 years
destruction and normal hip
normal
no fever
Other signs Treatment and therapy
  • child begins to limp—often without complaining of pain
  • may complain of pain in knee or thigh (or sometimes hip); gradually develops weakness for raising leg like this
    child lies on his side and raises leg up
  • For destruction: it may be best to do nothing, although many specialists still recommend casting, braces or surgery.
  • For slip: surgery to pin the cap into the right place may be needed.
DVC Ch15 Page 130-8.png



BELOW-KNEE PAIN (Osgood-Slater’s problem) Age it often begins: 11-18 years old
Pain in one or in several joints Fever
usually one knee only
leg with Osgood-Slater’s problem
knee cap
ligament
painful swelling over bone here due to loosening of bone surface
loosening of bone surface (seen on X-ray)
no fever
Other signs Treatment and therapy
  • especially in very active, strong children
  • may begin with pain after jumping, running, or forceful exercise
  • avoid forceful exercises or activities until pain goes away (usually in 2 to 3 years).
  • aspirin or ibuprofen and hot (or cold) soaks for pain.
  • the problem may last for years but in time will go away, although the bony bump remains.



‘HOT’ INFECTION Age it often begins: any age, but rarely in very young children
of a joint (bacterial infection: staphylococcus, streptococcus, typhoid, etc.) See Where There Is No Doctor
Pain in one or in several joints Fever
one hip knee or ankle joint rarely more than one joint often low fever, sometimes high fever, at least at first
Other signs Treatment and therapy
  • sometimes follows injury to joint or illness such as typhoid
  • usually begins suddenly
    DVC Ch15 Page 131-1.png
  • joint often red, hot, swollen
  • joint destruction may be severe–leading in time to a fused or ‘frozen’ joint, or *dislocation
  • Identify cause of infection (lab tests needed).
  • Treat with appropriate antibiotic.
  • Apply splint to avoid motion and activity during early stage.



‘COLD’ OR ‘SLOW’ INFECTION OF A JOINT Age it often begins: any age, but mostly in older children and young adults
tuberculosis (TB), (or less commonly, syphilis, gonorrhea, or fungus — which are not discussed here). See Where There Is No Doctor
Pain in one or in several joints Fever
one hip or knee, or in backbone (See TB of spine).
DVC Ch15 Page 131-2.png
  • joint may gradually become large or deformed, but not very hot or red.
  • often much pain (sometimes no pain until the bone or joint damage is severe)
no fever
hip swelling
warm, soft swelling
Other signs Treatment and therapy
  • often history of TB in family
  • only half of these children have signs of lung TB.
  • strongly positive TB skin test (test has meaning only in children not vaccinated against TB)
  • child often quite thin or sickly (but not always)
  • pain usually begins little by little and may become so bad that the child cannot move his leg.
  • anti-tuberculosis medicines (2 or 3) for at least 1 year (See Where There Is No Doctor.)
  • daily ROM exercises
  • aspirin or ibuprofen and hot soaks for pain
  • ‘exercises-without-motion’ to keep muscle strength



SPRAINS AND TORN LIGAMENTS Age it often begins: older child or adult
Pain in one or in several joints Fever
one joint only
DVC Ch15 Page 131-4.png

hot and swollen at first

no fever
Other signs Treatment and therapy
  • ankles and knees are common sites.
  • often results from forceful twisting
  • joint may be loose or floppy, and remain weak for months or years.
  • it may easily be twisted or injured again.
  • apply cold during first day after sprain; following days, apply heat.
  • avoid motion but keep joint in good position.
  • aspirin or ibuprofen for pain
  • provide temporary support with elastic or adhesive bandage or (in severe cases) a *cast or ankle brace.


INJURY TO JOINT SURFACE

Age it often begins: older child or adult
(for example: torn meniscus, bursitis)
Pain in one or in several joints Fever
usually one joint only, often the knee no fever
Other signs Treatment and therapy
  • usually after twist or strain or injury
  • may hurt suddenly or go weak at certain times but not at others
    swelling behind knee
  • swelling or ‘liquid’ under skin may form behind knee or on the edge of joint.
  • provide support with elastic bandage.
  • rest, moderate activity
  • gentle ROM exercises
  • aspirin or ibuprofen for pain
  • if problem continues, seek help of a specialist.



DISLOCATED JOINT DUE TO INJURY

Age it often begins: at birth or in older child
(dislocation is when a bone comes out of its socket)
Pain in one or in several joints Fever

one joint
Hips, shoulder, and elbows are most common.

no fever
Other signs Treatment and therapy
  • at first, very painful and weak
    deformed shoulder
  • in weeks or months (if uncorrected) pain becomes less but weakness often remains.
  • joint looks deformed.


  • have an experienced person try to put the bone back in its socket (the same day or soon after the dislocation occurs). Older dislocations and some new ones may need surgery.
  • provide support for a few weeks with elastic bandage (especially shoulders and knees).
  • gently do ROM exercises every day.


DISLOCATED JOINT DUE TO MUSCLE WEAKNESS

Age it often begins: occurs in older child with polio, other paralysis, or arthritis
or muscle imbalance
Pain in one or in several joints Fever

usually one joint

DVC Ch15 Page 131-7.png
weak shoulder dislocated from weight bearing
no fever
Other signs Treatment and therapy
  • deformed (strangely shaped) joints
  • knees, shoulders, hips, feet, elbows may gradually dislocate because muscles pulling them in one direction are stronger. or because muscles surrounding the joint are so weak.

DVC Ch15 Page 131-8.png

dislocated
  • careless stretching exercises may cause or increase dislocation.
  • try to put dislocated joint back into place.
  • avoid positions that force joint out again.
  • for partial dislocations of knee, careful stretching exercises may help—but take care to avoid further dislocation.




This page was updated:19 Jan 2018