What causes pediatric musculoskeletal disorders?

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The symptoms of MSK disorders in children can vary, depending on the underlying cause and type of the disorder.

According to Versus Arthritis, symptoms that may indicate a serious MSK disorder in a child include:

• severe joint pain
• a severe, painful, or chronic limp
• joint swelling
• deep, throbbing bone pain
• persistent night pain that does not respond to over-the-counter pain relief medication
• weakness
• regression, loss, or delay in motor milestones
• systemic symptoms, such as fatigue, weight loss, swollen lymph nodes, or a pale appearance

MSK disorders have various causes. Some conditions are congenital and present at birth, while others develop over time. Infection and tumors can also cause MSK issues. The following sections describe these causes in more detail.

Children are at especially high risk of infections. Many common infections are mild and treatable at home. However, others, such as those relating to MSK disorders, require attention from a healthcare professional.

Types

The most common MSK infections in children include osteomyelitis, an infection of the bone, and septic arthritis, an infection of the joints.

The bacteria Staphylococcus aureus most often causes osteomyelitis and septic arthritis. The bacteria may spread after entering through a wound or as a complication of another illness, such as chickenpox or an ear infection.

Osteomyelitis affects the bone marrow or bones. It is rare and affects around 1 in 5,000 children. It more commonly affects children under 5 years, and boys are twice as likely as girls to develop the infection.

Osteomyelitis in children may lead to complications, such as fractures, differences in limb length, and problems with range of motion. A doctor can typically treat the infection with antibiotics.

Septic arthritis affects 3 to 4 in 100,000 children in the United States. The infection most often occurs in boys and children under 5.

Without treatment, septic arthritis may permanently damage the joints. A doctor can treat the condition by draining fluid from the joint with a needle and prescribing antibiotics.

Read more about the causes of septic arthritis.

Malignant musculoskeletal tumors are rare in children. Signs of these types of cancer in children include unexplained bone pain and swelling and unexplained soft tissue lumps that are growing larger.

Types

Musculoskeletal cancers in children include bone tumors, which are most often:

• osteosarcoma
• soft tissue sarcoma, most often Rhabdomyosarcoma

Malignant bone tumors account for 6% of all childhood cancers.

Bone cancer usually affects children during adolescence and tends to develop in bones that are growing rapidly. These include the bones around the knee and in the upper arm.

Soft tissue sarcomas account for around 7% of childhood cancers. The tumors can form in any soft tissue of the body, including the muscles, nerves, joints, and tendons.

Treatment for bone cancer and soft tissue sarcomas usually includes surgery, radiation therapy, and chemotherapy.

A child with inflammatory arthritis may have swollen, painful joints, stiffness, new clumsiness, or an unwillingness to move around.

Types

The most common type of inflammatory arthritis in children is juvenile idiopathic arthritis (JIA). JIA refers to a group of conditions that cause joint inflammation in children.

JIA occurs slightly more often in girls and usually develops in children of preschool age and teens.

Researchers do not know the exact causes of JIA, but the MSK disorder occurs when the immune system mistakenly attacks the joints.

Treatment can include medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying anti-rheumatic drugs (DMARDs).

Progressive muscle conditions worsen over time. Muscular dystrophy (MD) refers to a group of more than 30 progressive muscle disorders. MD usually begins in childhood and requires lifelong treatment.

MD typically leads to muscle degeneration and weakness over time. This can affect various bodily movements and functions, including heart and lung function, which can shorten a person’s lifespan.

Types

There are many types of MD. The most common types include:

• Duchenne MD: This is the most common type of MD, which usually begins in early childhood. Someone with Duchenne MD will typically live into their 20s or 30s.
• Myotonic dystrophy: People with this type of MD may not have shortened lives unless the disorder is severe.
• Facioscapulohumeral MD: This type of MSK disorder is not usually life threatening and progresses slowly.
• Becker MD: This type of MD is related to Duchenne MD but is typically less severe.
• Emery-Dreifuss MD: This type occurs in childhood or during early adulthood. People with this type of MD usually live until at least middle age.

When a child presents with symptoms, such as joint or bone pain, doctors may first perform a physical examination and ask about a person’s family medical history.

A physical examination may include palpation, which involves a doctor gently feeling areas of the body with their hands. A doctor may also check for visual signs of infections, such as an inability to bear weight on the limb with the infection or the child’s ability to rotate the limb.

A doctor may then order several tests to help determine the cause. These may include:

• blood tests
• imaging tests, such as an X-ray, bone scan, MRI scan, CT scan, or PET scan
• biopsies of bone or soft tissue
• synovial fluid tests
• bone marrow tests

A person needs to contact a doctor if a child has symptoms of an MSK disorder.

Some MSK disorders, such as septic arthritis, can result in severe complications without treatment. Others, such as bone and soft tissue cancer and MD, require medical care to reduce the severity of symptoms and, in some cases, to prolong a person’s life.

Several pediatric musculoskeletal (MSK) disorders exist. These include infectious types, such as osteomyelitis and septic arthritis, cancers, such as bone and soft tissue sarcomas, inflammatory arthritis, and progressive muscle disorders.

Many types of MSK disorders are rare in children but can be severe.

A person needs to contact a doctor if their child has symptoms of an MSK disorder. The disorders typically require medical attention and may lead to severe complications without treatment.