Распространенные причины хронической боли в суставах у детей

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HealthWiki > Реабилитация детей с ограниченными возможностями здоровья > ГЛАВА 15: Боль в суставах > Распространенные причины хронической боли в суставах у детей

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• ГЛАВА 15: Боль в суставах
• Распространенные причины хронической боли в суставах у детей (боль, которая продолжается более 2 недель или постоянно возвращается)
• Как ухаживать за болезненными суставами
• Конструкции лечебных ванн
• Лекарства от боли

RHEUMATIC FEVER	Age it often begins: 5 to 15 years old
Pain in one or in several joints	Fever
Usually pain is in several joints. (Rarely it begins with severe pain and swelling in only one joint, but often there is also some pain in other joints.) Often pain starts in ankles and wrists, then knees and elbows. Pain may change from some joints to others.	High fever is typical (usually starts suddenly).
Other signs	Treatment and therapy
joint pain and fever usually begin 1-3 weeks after severe sore throat with fever (strep throat) small lumps may appear under the skin over joints sometimes wiggly reddish circles on skin in severe or advanced cases, heart problems (‘heart murmur’, difficulty breathing, or chest pain) usually gets better in 6 weeks to 3 months—but likely to come back	pencillin V ibuprofen with precautions to avoid stomach upset rest range-of-motion (ROM) exercises apply heat or cold to painful joints.

JUVENILE ARTHRITIS		Age it often begins: Any age, but often begins between 2-7 or 9-12 years old. Lasts for years (Often the arthritis gets better when child becomes sexually developed)
(also called juvenile rheumatoid arthritis or Still’s disease)
Pain in one or in several joints		Fever
May affect few joints, many joints, or almost all joints. (In ⅓ of children it begins in only one joint—later it may affect others.)		Often some fever when pain is worst. (Rarely, it begins with high fever.)
Other signs		Treatment and therapy
usually no history of sore throat severely painful, hot, swollen joints often leading to muscle weakness, contractures and deformities sometimes a rash that comes and goes may begin little by little, or suddenly and severely one or both eyes may become red and sore (iritis) and become damaged usually lasts for years with periods when it gets better and then worse		ibuprofen in high doses with precautions to avoid stomach upset apply heat or cold to painful joints ROM exercises exercises without motion to strengthen muscles lots of rest, but also moderate activity lots of understanding and support

DESTRUCTION OR SLIPPING OF CAP OF THIGH BONE AT THE HIP		Age it often begins: Destruction: mostly boys 4-8 years old Slip: mostly boys 11-16 years old
Pain in one or in several joints		Fever
Pain in one hip (rarely both) Destruction: Cap of head of thigh bone breaks into pieces and gradually re-forms in 2 to 3 years	normal	no fever
Other signs		Treatment and therapy
child begins to limp—often without complaining of pain may complain of pain in knee or thigh (or sometimes hip); gradually develops weakness for raising leg like this		for destruction: it may be best to do nothing, although many specialists still recommend casting, braces or surgery. for slip: surgery to pin the cap into the right place may be needed

BELOW-KNEE PAIN (Osgood-Schlatter disease)	Age it often begins: 11-18 years old
Pain in one or in several joints	Fever
usually one knee only knee cap ligament painful swelling over bone here due to loosening of bone surface loosening of bone surface (seen on X-ray)	no fever
Other signs	Treatment and therapy
especially in very active, strong children may begin with pain after jumping, running, or forceful exercise	avoid forceful exercises or activities until pain goes away (usually in 2 to 3 years) ibuprofen or paracetamol and hot (or cold) soaks for pain. the problem may last for years but in time will go away, although the bony bump remains

“HOT” INFECTION	Age it often begins: any age, but rarely in very young children
of a joint (bacterial infection: staphylococcus, streptococcus, typhoid, etc.) See Where There Is No Doctor
Pain in one or in several joints	Fever
one hip knee or ankle joint rarely more than one joint	often low fever, sometimes high fever, at least at first
Other signs	Treatment and therapy
sometimes follows injury to joint or illness such as typhoid usually begins suddenly joint often red, hot, swollen joint destruction may be severe–leading in time to a fused or ‘frozen’ joint, or dislocation	identify cause of infection (lab tests needed). treat with appropriate antibiotic. apply splint to avoid motion and activity during early stage.

“COLD” OR “SLOW” INFECTION OF A JOINT	Age it often begins: any age, but mostly in older children and young adults
tuberculosis (TB), (or less commonly, syphilis, gonorrhea, or fungus — which are not discussed here). See Where There Is No Doctor
Pain in one or in several joints	Fever
one hip or knee, or in backbone (See TB of spine). joint may gradually become large or swollen, but not very hot or red. often much pain (sometimes no pain until the bone or joint damage is severe)	no fever
warm, soft swelling
Other signs	Treatment and therapy
often history of TB in family only half of these children have signs of lung TB strongly positive TB skin test (test has meaning only in children not vaccinated against TB) child often quite thin or sickly (but not always) pain usually begins little by little and may become so bad that the child cannot move his leg	anti-tuberculosis medicines (2 or 3) for at least 1 year (see Where There Is No Doctor.) daily ROM exercises ibuprofen or paracetamol and hot soaks for pain “exercises-without-motion” to keep muscle strength

SPRAINS AND TORN LIGAMENTS	Age it often begins: older child or adult
Pain in one or in several joints	Fever
one joint only hot and swollen at first	no fever
Other signs	Treatment and therapy
ankles and knees are common sites. often results from forceful twisting joint may be loose or floppy, and remain weak for months or years it may easily be twisted or injured again	apply cold during first day after sprain; following days, apply heat avoid motion but keep joint in good position ibuprofen or paracetamol for pain provide temporary support with elastic or adhesive bandage or (in severe cases) a *cast or ankle brace

INJURY TO JOINT SURFACE	Age it often begins: older child or adult
(for example: torn meniscus, bursitis)
Pain in one or in several joints	Fever
usually one joint only, often the knee	no fever
Other signs	Treatment and therapy
usually after twist or strain or injury may hurt suddenly or go weak at certain times but not at others swelling or ‘liquid’ under skin may form behind knee or on the edge of joint.	provide support with elastic bandage rest, moderate activity gentle ROM exercises ibuprofen or paracetamol for pain if problem continues, seek help of a specialist

DISLOCATED JOINT DUE TO INJURY	Age it often begins: at birth or in older child
(dislocation is when a bone comes out of its socket)
Pain in one or in several joints	Fever
one joint Hips, shoulder, and elbows are most common.	no fever
Other signs	Treatment and therapy
at first, very painful and weak in weeks or months (if uncorrected) pain becomes less but weakness often remains joint looks different from same joint on other side of body	have an experienced person try to put the bone back in its socket (the same day or soon after the dislocation occurs). Older dislocations and some new ones may need surgery provide support for a few weeks with elastic bandage (especially shoulders and knees) gently do ROM exercises every day

DISLOCATED JOINT DUE TO MUSCLE WEAKNESS	Age it often begins: occurs in older child with polio, other paralysis, or arthritis
or muscle imbalance
Pain in one or in several joints	Fever
usually one joint weak shoulder dislocated from weight bearing	no fever
Other signs	Treatment and therapy
atypically-shaped joints knees, shoulders, hips, feet, elbows may gradually dislocate because muscles pulling them in one direction are stronger. or because muscles surrounding the joint are so weak. dislocated careless stretching exercises may cause or increase dislocation.	try to put dislocated joint back into place avoid positions that force joint out again for partial dislocations of knee, careful stretching exercises may help—but take care to avoid further dislocation

This page was updated:15 ноя 2023