: : My som is 11yrs. old. For the past year or so, he has expirenced leg
: : pains mostly in his right leg the calf or thigh. The pains don't wake
: : him at night and are not growing pains. His ped. doesn't know what they
: : are caused by. The only test he has had for this is one x-ray which
: : showed nothing. He has Epidermal Nevus syndrome, GERD, fine & gross motor
: : delays, frequant migraine and tension headaches. My mother suggested
: : lupus because a cousin or hers has it as an adult. The pain occurs when
: : he has been active even after a short time, but also ocures when he has
: : been watching tv or playing quietly. He is generaly not active, we can
: : never get him to play outside, he had to quite Karate class last Feb.
: : because of this & his headaches. Any ideas would be greatly apreciated.
: : Thank you
: : Cathy
: Dear Cathy :
: It would be helpful if you can describe his leg pains , are they dull , sharp , pulsating , do you see any swelling in the surroundings especially the joints , is there any tenderness when you touch his leg at the time he has the pain , can he localize the pain , is it always in the same location , where exactly on his leg does it hurt . Can you describe his gross and fine motor delay ? it would help to identify any muscle spasm . Does he limp when he has / does not have the pain , any associated fevers ?
: Does he have good control of his bladder and bowel movements ? How much does he weigh ?
: Growing pains may still be a cause although not in their typical presentation. As pediatricians , we are always cautious about diagnosing leg pains as growing pains as many pathologies can cause the same symptoms.
: Growing pains are usual between 3-12 years of age , the child is growing and developing normally , has intermittent aches ( dull) and pains alternating between the calves and thighs , poorly localized , no joint involvement , no limping , no disability or inflammation. Responds well to supportive measures including heat and massage.
: Systemic lupus is not a easy disease , it usually presents in teenage and young adult females , it has many presentations , there's no denial that you can have leg pains in lupus but that is not the major complaint. Criteria to diagnose SLE include ,ongoing fevers , a malar rash on the face like a butterfly , photosenstivity , mouth ulcers , arthritis , chest pain due to inflammation of the lung lining called the pleura , kidney problems with blood in urine , seizures , anemia , low platelet counts , and if a combination of these manifestations is present , then a tst for antinuclear antibodies can be done , which may help in diagnosing SLE .
: Leg length discrepency is another cause for muscles to become spastic due to the imbalance between the muscle groups trying to overcome the discrepency . This could be identified from a subtle limp and a comparison of leg length measurements.
: If the pain was shooting and sharp in nature mainly on the side of the thigh and leg , a compression of the nerve emerging from the vertebral column maybe a cause of leg pain . That would be detected from a good neurological examination and an X-ray of the spine.
: Malignancies can present with leg pain including leukemia , lymphoma , or bone tumors. Remember , the child would be very sick , having high fevers , pain would be severe enough to keep him awake at night , he would show signs of anemia and have an increased bleeding tendency . Bone X-ray can be helpful in bone tumors , and a complete blood count and smear would help rule out leukemias.
: There is no correlation between leg pains and GERD , migraines /tension headaches . Epidermal nevus syndrome has been associated with skeletal deformities .
: The causes of leg pain are numerous , namely any disease that can affect muscle , bone , soft tissue or nerves and vessels . Advise : if this pain persists , gets worse , has associated new symptoms or signs , a follow up visit to his pediatrician would be warranted.
: Thank you
: Disclaimer : this information is provided for academic purposes only.
: keywords: Growing pains*( general pediatrics) , SLE*( rheumatology) , Epidermal nevus*( dermatology), Limp*(orthopedics)
RE: RE: leg pains,
Thank you for your quick response. My son weighs 67lbs, 4"5". The leg
pains are an ache, on the calf and/or the front, back, and inner thigh.
He has limped with the pain but not usually. He is able to walk and run
with the pain, but I discourage this as I don't want the pain to worsen.
On 9-13-98 we went to an amusment park, being there apx. 1/2 hour, his
leg started to hurt, this continued all day & at night, the next day and
even this morning 9-15-98 he is complining of the pain. He does not have
a fever, swelling, redness, or hot spots. I see no leg size discrepancy,
his motor delays are mild low muscle tone, and muscle strength,he still
can't cut food or open candy wrappers etc . has problems with most snaps
and some zippers, has a seizure disorder he has had an x-ray of his spine
to check for scholiosis, which he doesn't yet have,though his lower back
appears to curve in a little too much. Could this be a form of mild
cerebral palsy? or muscular distrophy?How would we find out?
Dear cathy :
I am not sure if the X-rays that were done included the hips. It's worth checking for what is called " slipped capital femoral epiphysis" or SCFE.
This may present with similar symptoms , in the form of referred pain from the hip, and is diagnosed by a bilateral hip X-ray.
A second opinion from a pediatric neurologist , with a complete neurological physical examination can help identify the difference between muscular dystrophies ( and there are many forms) or a very mild form of cerebral palsy. Cerebral palsy children , even in their mildest forms , suffer from increased muscle tone , tiptoeing and hypersensitive joint reflexes( hyperreflexia).
Please keep us posted and thank you
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