unexplained leg pains

[Cathy__0]

  : :   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
  : L.M.
  :
  : 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?
    Thanks again
    Cathy

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
L.M.