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Leg pain in 5 yr old - day and night, on meds
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Leg pain in 5 yr old - day and night, on meds

5 yr old son complained of night leg pains for months - waking in tears.  When this seemed to be excessive (lasted for 4 months, increasing frequency), we saw docs who diagnosed as "growing pains".  By Aug 2011 he wasn't playing normally during the day because "his leg hurt" and on the bad days, he limped.  There was a "hot spot" midway down the inside of his tibia.  - he jumped if we poked it.  
Xray was positive:  he had periosteal reaction and "something" visible in the bone.
Nov: more periosteal reaction seen in XRay, suspected Osteoid Osteoma
Dec: CT and bonescan were negative for Osteoma
Our ortho showed his tests to other docs and radiologists.  Some thought it was possibly an old fracture.  
By Dec, our son was in constant pain.  We used Naprosyn (supplemented with Tylenol) to manage it day and night.
After a regular (and fairly high) dose of Naprosyn, the periosteal reaction went away.  

He was put in a lower leg cast for 4 weeks.  The pain frequency decreased significantly and we were back down to the occasional Over-the-counter meds.  The intensity was still quite high at times but only every few days.

The cast has been off for a week and a half.  He now walks with his toe pointed outward.  When he's having a rough day, it's pointed almost 90 degrees outward or he just hops around.   We use 10% Diclofenac gel and heat as our first choice to manage the pain.  He seems to be in constant discomfort again..ranging from mild to severe.  

He is an otherwise healthy, active little boy.  His height:weight is normal and he is generally on the small end of both scales.

Any possible diagnosis?  I understand that any nasty bone tumors have been ruled out by the bonescan & CT.  Is there a possible soft tissue cause?  We assume that it is not likely to have been a fracture or it should've healed with 4 weeks in a cast.  Also, there was no acute injury or date that we could say this started..  Like any little boy, he's had many minor incidences but nothing notable.

Any help appreciated.  We are waiting on an MRI (in a few months).  I don't want to go back to the constant meds!

Thanks.
Tags: leg pain, pediatric, osteoid osteoma, Soft Tissue Sarcomas
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19 Comments Post a Comment
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134578_tn?1404951303
I'd put him back into a cast if it is what made him comfortable, rather than going back on constant meds, and insist the MRI be much sooner.
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Avatar_f_tn
Thank you for the comment.

If we knew it would only be very short-term, we would ask for another cast.  The problem is, his little calf was already quite atrophied from the 4 weeks.  4 weeks is a long time for a pre-schooler.  

Also, the cast was most helpful in the first week, before he figured out how to run/jump/play as if it wasn't there.  ;)  (It was a "walking" cast)
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535822_tn?1389452880
I would certainly see if you can get an MRI sooner, a few months sounds too much for a child in this kind of pain.I would think it would be a priority.You may have to put him back on pain meds  till you have it done and get a diagnosis.Put this question onto the Othopedics forum see if they have ideas what could be the cause
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Avatar_f_tn
Thanks.  I'll try the orthopedic forum (I'm new to this!).  

We are hoping to move the MRI sooner.  I doubt it will happen until we are unable to manage the pain.. ugh.  Our ortho is "stumped" and suggested we wait a few months to "see how it goes".  (the MRI will likely require general anesthetic) But after MONTHS of increasing pain, we are not satisfied with waiting.

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535822_tn?1389452880
No and I dont blame you the dear boy suffering like this ,I always thought they put children first, what pain meds do they give you for the pain ? well welcome to Med Help , many good forums especially about children,also groups to join , they may have more information on the Ortho forum .worth checking out good luck let us know how it goes .
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Avatar_f_tn
Thanks.  For pain meds, he has Naprosyn (naproxen suspension) and Diclofenac gel (higher concentration for ortho issues), and the usual over-th-counter - Advil/Tylenol.

I don't offer meds when I notice discomfort anymore.  I try to wait until he asks.  (unless he's reduced to hopping on one foot).  It's a tricky balance between feeling like I'm letting him suffer vs. giving a little guy too much meds.   Also, he's a typical kid.  He doesn't want to stop moving so he doesn't always acknowledge the pain until later in the day when he slows down.  Then he tells me it's been hurting all day etc.  
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535822_tn?1389452880
Thats good thinking that way hes not getting too much, you are an aware Mom you know too many meds are not a good thing .let us know when you have the MRI done .good luck
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Avatar_m_tn
a friend of mine has a daughter about 6 yrs old with this problem. they scared her so bad by saying it was bone cancer. they did the x rays and of course it was ruled out they told her she had alot of hot spots. what happens is when they r bow legged as toddlers some kids bones dont fully go back to normal so now that they r growing they get growing pains bc there bones r not where they should be. i really wish i could remember what they did for her. maybe take him to an orthopedic if you havent done so yet. he may need physical therapy its worth a shot hope i help =)
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Avatar_m_tn
oh i see you did take him to an ortho.
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Avatar_f_tn
Yes (we took him to an ortho).  But what do you mean they saw "hotspots"?  On the xray, bonescan, or CT?  --I know it wasn't your kid so you may no remember the details.  

In our case, they see one area of "something" on the xray and CT in particular.  They also see periosteal reaction (inflammation around bone) in that area.  The bonescan was neg so no new bone growth, therefore no bone cancer.
Thanks
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jemma116
United Kingdom