View source for Disabled Village Children:Common Causes of Chronic Joint Pain in Children (Pain That Lasts More Than 2 Weeks or Keeps Coming Back)

{{bctrail|segments=3|chaptitle=Chapter 15: Painful Joints}}
{{DISPLAYTITLE:Common Causes of Chronic Joint Pain in Children (Pain That Lasts More Than 2 Weeks or&nbsp;Keeps Coming Back)}}
{{SideSupplement|bookabbreviation=dvc|pagealt=is from pages 130 to 131 of|chapterpdf=http://hesperian.org/wp-content/uploads/pdf/en_dvc_2023/en_dvc_2023_15.pdf|bookurl=Disabled Village Children|booktitle=Disabled Village Children}}
{{chaptertoc|In this chapter:|
 <ul class{{=}}"noprint">
<li>[[Disabled Village Children:Chapter 15: Painful Joints|Chapter 15: Painful Joints]]</li>
    <li>[[Disabled Village Children:Common Causes of Chronic Joint Pain in Children (Pain That Lasts More Than 2 Weeks or Keeps Coming Back)|Common Causes of Chronic Joint Pain in Children (Pain That Lasts More Than 2 Weeks or Keeps Coming Back)]]</li>
    <li>[[Disabled Village Children:How to Care for Painful Joints|How to Care for Painful Joints]]</li>
    <li>[[Disabled Village Children:Designs for Therapy Baths|Designs for Therapy Baths]]</li>
    <li>[[Disabled Village Children:Information On Aspirin and Ibuprofen for Swollen Joints in Persons with Arthritis or Rheumatic Fever|Medicines for Pain]]</li>
 </ul>
}}
{{clr}}

<table frame=box width=100% cellspacing=0 cellpadding=10>
<tr>
<td  style="border-bottom:1px solid;border-right:1px solid;font-size:130%;"> '''[[Disabled_Village_Children:Chapter_17:_Rheumatic_Fever|RHEUMATIC FEVER]]'''</td>
<td style="border-bottom:1px solid;width:50%;">'''Age it often begins: '''5 to 15 years old</td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td style="width:50%;border-bottom:1px solid;border-right:1px solid;">'''Pain in ''one'' or in ''several'' joints'''</td>
<td style="border-bottom:1px solid;">'''Fever'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;">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.</td>
<td>High fever is typical (usually starts suddenly).<br>
[[Image:DVC_Ch15_Page_130-2.png|30px|center]]</td></tr>

<tr valign=top>
<td style="border-bottom:1px solid;border-right:1px solid;">[[Image:DVC_Ch15_Page_130-1.png|200px]]</td>
<td  style="border-bottom:1px solid;"></td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td style="border-bottom:1px solid;border-right:1px solid;">'''Other signs'''</td>
<td style="border-bottom:1px solid;">'''Treatment and therapy'''</td></tr>

<tr>
<td style="border-right:1px solid;">
*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</td>

<td valign=top>
*pencillin V 
*[[Disabled_Village_Children:Information_On_Aspirin_and_Ibuprofen_for_Swollen_Joints_in_Persons_with_Arthritis_or_Rheumatic_Fever|ibuprofen]] with precautions to avoid stomach upset
*rest
*range-of-motion (ROM) exercises
*apply heat or cold to painful joints.</td></tr>
</table>


<table frame=box width=100% cellspacing=0 cellpadding=10>
<tr valign=bottom>
<td  colspan=2 style="width:50%;border-right:1px solid;font-size:130%;"> '''[[Disabled_Village_Children:Chapter_16:_Juvenile_Arthritis:_Chronic_Arthritis_in_Children|JUVENILE ARTHRITIS]]'''</td>

<td rowspan=2 style="width:50%;border-bottom:1px solid;">'''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)</td></tr>

<tr valign=top>
<td colspan=2 style="border-bottom:1px solid;border-right:1px solid;">(also called juvenile rheumatoid arthritis or Still’s disease)'''</td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td colspan=2 style="width:60%;border-bottom:1px solid;border-right:1px solid;width:50%;">'''Pain in ''one'' or in ''several'' joints'''</td>
<td style="border-bottom:1px solid;">'''Fever'''</td></tr>

<tr valign=top>
<td style="width:25%;">May affect '''few''' joints, many joints, or almost all joints.<br><br> (In &#8531; of children it begins in only one joint—later it may affect others.)</td>
<td style="border-right:1px solid;width:25%;">[[Image:DVC_Ch15_Page_130-3.png|60px|center]]</td>
<td>Often some fever when pain is worst. (Rarely, it begins with high fever.)<br>
[[Image:DVC_Ch15_Page_130-2.png|30px|center]]</td></tr>


<tr valign=top style="background-color:#e6e6e6;">
<td colspan=2 style="border-bottom:1px solid;border-right:1px solid;border-top:1px solid;">'''Other signs'''</td>
<td style="border-bottom:1px solid;border-top:1px solid;">'''Treatment and therapy'''</td></tr>

<tr>
<td colspan=2 style="border-right:1px solid;">
*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[[Image:DVC_Ch15_Page_130-5.png|100px|right]]
*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</td>

<td valign=top>
*[[Disabled_Village_Children:Information_On_Aspirin_and_Ibuprofen_for_Swollen_Joints_in_Persons_with_Arthritis_or_Rheumatic_Fever|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</td></tr>
</table>


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<tr valign=top>
<td  colspan=2 style="width:50%;border-right:1px solid;border-bottom:1px solid;font-size:120%;"> '''[[Disabled_Village_Children:Hip_Problems_Due_to_Destruction_or_Slipping_of_the_Cap_of_the_Thigh_Bone|DESTRUCTION OR SLIPPING OF CAP OF THIGH BONE AT THE HIP]]'''</td>

<td colspan=2 style="width:50%;border-bottom:1px solid;">'''Age it often begins: '''
Destruction: mostly boys 4-8 years old<br>
Slip: mostly boys 11-16 years old</td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td colspan=2 style="width:60%;border-bottom:1px solid;border-right:1px solid;">'''Pain in ''one'' or in ''several'' joints'''</td>
<td colspan=2 style="border-bottom:1px solid;">'''Fever'''</td></tr>

<tr valign=top>
<td style="width:25%;">Pain in '''one hip''' (rarely both)<br>Destruction: Cap of head of thigh bone breaks into pieces and gradually re-forms in 2 to 3 years</td>
<td style="border-right:1px solid;width:25%;">
<div style="position:relative; width:110px;">
[[Image:DVC_Ch15_Page_130-6.png|100px|center|alt=destruction and normal hip]]
<div style="position:absolute; top:80px; left:40px;">normal</div></div></td>

<td>no fever</td></tr>


<tr valign=top style="background-color:#e6e6e6;">
<td colspan=2 style="border-bottom:1px solid;border-right:1px solid;border-top:1px solid;">'''Other signs'''</td>
<td colspan=2 style="border-bottom:1px solid;border-top:1px solid;">'''Treatment and therapy'''</td></tr>

<tr>
<td colspan=2 style="border-right:1px solid;">
*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<br>[[Image:DVC_Ch15_Page_130-7.png|150px|right|alt=child lies on his side and raises leg up]]
</td>

<td valign=top style="width:25%;">
*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
</td>
<td style="width:25%;">[[Image:DVC_Ch15_Page_130-8.png|100px|right]]</td></tr>
</table>
<div class{{=}}page-break></div>

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<td  style="width:50%;border-right:1px solid;border-bottom:1px solid;font-size:120%;"> '''[[Disabled_Village_Children:Chapter_15:_Painful_Joints|BELOW-KNEE PAIN (Osgood-Schlatter disease)]]'''</td>

<td style="width:50%;border-bottom:1px solid;">'''Age it often begins: ''' 11-18 years old
</td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td style="border-bottom:1px solid;border-right:1px solid;">'''Pain in ''one'' or in ''several'' joints'''</td>
<td style="border-bottom:1px solid;">'''Fever'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;">usually '''one''' knee only<br>
<div class=speechbub style="position:relative; height:160px;margin-top:30px;">[[Image:DVC_Ch15_Page_130-9.png|100px|center|alt=leg with Osgood-Slater’s problem]]
<div style="position:absolute; top:-10px;left:35px;font-style:normal; text-align:left;">knee cap</div>
<div style="position:absolute; top:30px;left:35px;font-style:normal; text-align:left;">ligament</div>
<div style="position:absolute; top:65px;left:20px;width:110px;font-style:normal; text-align:left;">painful swelling over bone here due to loosening of bone surface</div>
<div style="position:absolute; top:10px;left:215px;width:110px;font-style:normal; text-align:left;">loosening of bone surface (seen on X-ray)</div></div></td>
<td style="width:50%;">no fever</td></tr>


<tr valign=top style="background-color:#e6e6e6;">
<td style="border-bottom:1px solid;border-right:1px solid;border-top:1px solid;">'''Other signs'''</td>
<td style="border-bottom:1px solid;border-top:1px solid;">'''Treatment and therapy'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;">
*especially in very active, strong children
*may begin with pain after jumping, running, or forceful exercise</td>

<td valign=top >
*avoid forceful exercises or activities until pain goes away (usually in 2 to 3 years)
*ibuprofen or paracetamol  and hot (or cold) soaks for pain.
*the problem may last for years but in time will go away, although the bony bump remains</td>
</tr>
</table>




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<tr>
<td  style="border-right:1px solid;font-size:130%;">'''“HOT” INFECTION ''' </td>
<td rowspan=2 style="border-bottom:1px solid;width:50%;">'''Age it often begins: ''' any age, but rarely in very young children </td></tr>

<tr>
<td  style="border-bottom:1px solid;border-right:1px solid;">of a joint (bacterial infection: staphylococcus, streptococcus, typhoid, etc.) See [https://store.hesperian.org/prod/Where_There_Is_No_Doctor.html ''Where There Is No Doctor'']</td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td  style="width:50%;border-bottom:1px solid;border-right:1px solid;">'''Pain in ''one'' or in ''several'' joints'''</td>
<td style="border-bottom:1px solid;">'''Fever'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;">
'''one''' hip knee or ankle joint rarely more&nbsp;than&nbsp;one&nbsp;joint </td>
<td>often low fever, sometimes high fever, at least at first </td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td   style="border-bottom:1px solid;border-right:1px solid;border-top:1px solid;">'''Other signs'''</td>
<td style="border-bottom:1px solid;border-top:1px solid;">'''Treatment and therapy'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;"><div class{{=}}page-break></div>
*sometimes follows injury to joint or illness such as typhoid 
*usually begins suddenly[[Image:DVC_Ch15_Page_131-1.png|130px|right]]
*joint often red, hot, swollen
*joint destruction may be severe–leading in time to a fused or ‘frozen’ joint, or 
*dislocation
</td>

<td><div class{{=}}page-break></div>
*identify cause of infection (lab tests needed). 
*treat with appropriate antibiotic. 
*apply splint to avoid motion and activity during early stage.

</td></tr>
</table>




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<tr>
<td  style="border-right:1px solid;font-size:130%;">'''“COLD” OR “SLOW” INFECTION OF A JOINT''' 
</td>
<td rowspan=2 style="border-bottom:1px solid;width:50%;">'''Age it often begins: ''' any age, but mostly in older children and young adults </td></tr>

<tr>
<td  style="border-bottom:1px solid;border-right:1px solid;">tuberculosis (TB), (or less commonly, syphilis, gonorrhea, or fungus — which are not discussed here). See [https://store.hesperian.org/prod/Where_There_Is_No_Doctor.html ''Where There Is No Doctor'']</td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td  style="width:50%;border-bottom:1px solid;border-right:1px solid;">'''Pain in ''one'' or in ''several'' joints'''</td>
<td style="border-bottom:1px solid;">'''Fever'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;">'''one''' hip or knee, or in backbone (See [[Disabled_Village_Children:Chapter_21:_Tuberculosis_of_the_Backbone:_Pott’s_Disease|TB of spine]]). [[Image:DVC_Ch15_Page_131-2.png|70px|right]]
*joint may gradually become large or swollen, but not very hot or red.
*often much pain (sometimes no pain until the bone or joint damage is severe) 
 </td>
<td rowspan=2 style="border-bottom:1px solid;">no fever </td></tr>

<tr>
<td style="border-right:1px solid;border-bottom:1px solid;"> <div style="position:relative;">[[Image:DVC_Ch15_Page_131-3.png|100px|center|alt=hip swelling]]
<div style="position:absolute; left:30px; top:80px;width:90px; line-height:100%;">warm, soft swelling</div></div></td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td   style="border-bottom:1px solid;border-right:1px solid;border-top:1px solid;"><div class{{=}}page-break></div>'''Other signs'''</td>
<td style="border-bottom:1px solid;border-top:1px solid;"><div class{{=}}page-break></div>'''Treatment and therapy'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;">
*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&nbsp;leg</td>

<td>
*anti-tuberculosis medicines (2 or 3) for at least 1 year (see [https://store.hesperian.org/prod/Where_There_Is_No_Doctor.html ''Where There Is No Doctor''].) 
*daily ROM exercises 
*ibuprofen or paracetamol and hot soaks for pain
*“exercises-without-motion” to keep muscle strength
</td></tr>
</table>


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<tr>
<td  style="border-right:1px solid;border-bottom:1px solid;font-size:130%;">'''SPRAINS AND TORN LIGAMENTS'''
</td>
<td style="border-bottom:1px solid;width:50%;">'''Age it often begins: ''' older child or adult </td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td  style="width:50%;border-bottom:1px solid;border-right:1px solid;">'''Pain in ''one'' or in ''several'' joints'''</td>
<td style="border-bottom:1px solid;">'''Fever'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;border-bottom:1px solid;">'''one''' joint only 
[[Image:DVC_Ch15_Page_131-4.png|100px|right]]
hot and swollen at first
 </td>
<td style="border-bottom:1px solid;">no fever</td></tr>


<tr valign=top style="background-color:#e6e6e6;">
<td   style="border-bottom:1px solid;border-right:1px solid;border-top:1px solid;">'''Other signs'''</td>
<td style="border-bottom:1px solid;border-top:1px solid;">'''Treatment and therapy'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;">
*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
</td>

<td>
*apply cold during first day after sprain; following days, apply heat 
*avoid motion but keep joint in good position 
*ibuprofen or paracetamol for pain 
*provide temporary support with elastic or adhesive bandage or (in severe cases) a *cast or ankle brace

</td></tr>
</table>

<div class{{=}}page-break></div>
<table frame=box width=100% cellspacing=0 cellpadding=10>
<tr>
<td  style="border-right:1px solid;font-size:130%;">
'''INJURY TO JOINT SURFACE''' 
</td>
<td rowspan=2 style="border-bottom:1px solid;width:50%;">'''Age it often begins: ''' older child or adult </td></tr>

<tr>
<td style="border-right:1px solid;border-bottom:1px solid;">(for example: torn meniscus, bursitis)</td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td  style="width:50%;border-bottom:1px solid;border-right:1px solid;">'''Pain in ''one'' or in ''several'' joints'''</td>
<td style="border-bottom:1px solid;">'''Fever'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;border-bottom:1px solid;">usually '''one''' joint only, often the knee
 </td>
<td style="border-bottom:1px solid;">no fever</td></tr>


<tr valign=top style="background-color:#e6e6e6;">
<td   style="border-bottom:1px solid;border-right:1px solid;border-top:1px solid;">'''Other signs'''</td>
<td style="border-bottom:1px solid;border-top:1px solid;">'''Treatment and therapy'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;">
*usually after twist or strain or injury 
*may hurt suddenly or go weak at certain times but not at others [[Image:DVC_Ch15_Page_131-5.png|130px|right|alt=swelling behind knee]]
*swelling or ‘liquid’ under skin may form behind knee or on the edge of joint. 
</td>

<td>
*provide support with elastic bandage 
*rest, moderate activity 
*gentle ROM exercises 
*ibuprofen or paracetamol for pain 
*if problem continues, seek help of a specialist
</td></tr>
</table>


<table frame=box width=100% cellspacing=0 cellpadding=10>
<tr>
<td  style="border-right:1px solid;font-size:130%;">
'''DISLOCATED JOINT DUE TO INJURY''' 
</td>
<td rowspan=2 style="border-bottom:1px solid;width:50%;">'''Age it often begins: ''' at birth or in older child </td></tr>

<tr>
<td style="border-right:1px solid;border-bottom:1px solid;">(dislocation is when a bone comes out of its socket)</td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td  style="width:50%;border-bottom:1px solid;border-right:1px solid;">'''Pain in ''one'' or in ''several'' joints'''</td>
<td style="border-bottom:1px solid;">'''Fever'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;border-bottom:1px solid;">
'''one joint'''<br>Hips, shoulder, and elbows are most common.
 </td>
<td style="border-bottom:1px solid;">no fever</td></tr>


<tr valign=top style="background-color:#e6e6e6;">
<td   style="border-bottom:1px solid;border-right:1px solid;border-top:1px solid;">
<div class{{=}}page-break></div>'''Other signs'''</td>
<td style="border-bottom:1px solid;border-top:1px solid;">
<div class{{=}}page-break></div>'''Treatment and therapy'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;">
*at first, very painful and weak <div style="position:relative; float:right;margin-top:45px;">[[Image:DVC_Ch15_Page_131-6.png|80px|right|alt=deformed shoulder]] </div>
*in weeks or months (if uncorrected) pain becomes less but weakness often remains
*joint looks different from same joint on other side of body
</td>

<td>
*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
</td></tr>
</table>

<table frame=box width=100% cellspacing=0 cellpadding=10>
<tr>
<td  style="border-right:1px solid;font-size:130%;">
'''DISLOCATED JOINT DUE TO MUSCLE WEAKNESS''' 
</td>
<td rowspan=2 style="border-bottom:1px solid;width:50%;">'''Age it often begins: ''' occurs in older child with polio, other paralysis, or arthritis</td></tr>
<tr>
<td style="border-right:1px solid;border-bottom:1px solid;">or muscle imbalance</td></tr>

<tr valign=top style="background-color:#e6e6e6;">
<td  style="width:50%;border-bottom:1px solid;border-right:1px solid;">'''Pain in ''one'' or in ''several'' joints'''</td>
<td style="border-bottom:1px solid;">'''Fever'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;border-bottom:1px solid;">
usually '''one''' joint 
<div style="position:relative;width:300px;">[[Image:DVC_Ch15_Page_131-7.png|120px|right]]
<div style="position:absolute; line-height:110%;left:70px; top:30px;width:110px;">weak shoulder dislocated from weight bearing</div></div>
 </td>
<td style="border-bottom:1px solid;">no fever</td></tr>


<tr valign=top style="background-color:#e6e6e6;">
<td   style="border-bottom:1px solid;border-right:1px solid;border-top:1px solid;">'''Other signs'''</td>
<td style="border-bottom:1px solid;border-top:1px solid;">'''Treatment and therapy'''</td></tr>

<tr valign=top>
<td style="border-right:1px solid;">
*atypically-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.
<div style="position:relative; width:150px;float:right;">
[[Image:DVC_Ch15_Page_131-8.png|130px]]
<div style="position:absolute;top:55px; left:60px;">dislocated</div></div>
*careless stretching exercises may cause or increase dislocation. 

</td>

<td>
*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 [[Disabled_Village_Children:Common_Sense_Precautions_When_Doing_Exercises|avoid further dislocation]] 

</td></tr>
</table>






{{Previous and next sections|Chapter 15: Painful Joints|How to Care for Painful Joints}}
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