Joint pain in children and adolescents [Gelenkschmerzen im kindes- und jugendalter]

In paediatrics, limb pain is among the most frequent causes for consultation. In the absence of pathognomonic manifestations and since laboratory and apparative investigations often can only exclude other causes, history and physical examination are of paramount importance. Inflammatory causes are to be distinguished from non-inflammatory causes. The classical inflammatory symptom, the arthritis, is the central aspect of illness of the arthritic disorders including coxitis fugax and juvenile rheumatoid arthritis. It may be difficult to distinguish other disorders accompanied by arthritis in which arthritis may be the leading symptom initially, including purpura Henoch-Schonlein and systemic lupus erythematosus. Non-inflammatory causes of limb pain in children and adolescents are much more frequent, especially trauma. The abounding 'growing pains' should be recognized. Although many causes of limb pain are of no lasting harm it is necessary to exclude diseases which require immediate intervention, i.e. septic arthritis/osteomyelitis and malignant disorders including acute lymphatic leukemia and solid tumors. The successful management of children and adolescents with chronic diseases of the limbs requires experience and in case of non-inflammatory disorders often the interdisciplinary cooperation of the pediatric orthopedic surgeon, and in case of inflammatory disorders consultation with the pediatric rheumatologist.