Leg and hip pain, 9 year old boy, all thoughts welcome.

[hellymelly]

I'm posting this for my friend, as she isn't a regular mner, and she is also a single parent, with no input from the child's father, so this is very stressful for her. Anyway, her ds is 9, he is average height I would say, slim, likes to be active. He has had leg pain for the past 12 months. Initially my friend assumed this was growing pain, she took him to the GP when it didn't go away, he was referred to a consultant who thought he perhaps had pain coming from a tendon in his groin. There was no treatment plan suggested. The pain has increased somewhat, it isn't constant, but if he has to walk home at the end of the school day (10-15 min wlk) he will cry with the pain and struggle with the length of the walk. The pain was mainly in the upper legs, but is now frequently in his hips/pelvis. It is a deep ache with occasional twingey nerve type pain. He is fairly run down, pale, gets colds a lot, that sort of thing, and is doesn't cope with heat well (that has been true since babyhood). He sometimes also complains of shoulder or ankle pain but this is only occasional.
My friend has been back to the gP and is waiting for another appointment with the same consultant, but I suggested posting here for her and she thought it might be very helpful to know if anyone else has a child with these symptoms, as then it would give her questions to ask at her appointment when she gets it, and/or might give some insight into what could be causing his pain. Thanks all!

Bumping for the evening crowd!

Might it be Perthes disease?

www.patient.co.uk/health/perthes-disease-leaflet

en.wikipedia.org/wiki/Legg%E2%80%93Calv%C3%A9%E2%80%93Perthes_syndrome

Apparently the consultant ruled out Perthes- he had an x-ray so I am assuming that was the thing that ruled it out? Consultant just wasn't sure what is going on, the tendon was his only suggestion, which means my friend is really worrying about it. He is in a lot of pain, and it doesn't seem right that a 9 year old boy can't walk home from school without the pain being enough to make him cry.

I'm sure that they've ruled it out, but my brother had this at 11 - it was missed for months, so I'm paranoid about it being missed in others!

en.wikipedia.org/wiki/Slipped_capital_femoral_epiphysis

Oh thanks for that, was your brother x-rayed? I hope he is ok now, as it sounds horrible.

Could be hypermobility syndrome? It could be that his pelvis is unstable and causing pain in his legs. I'm just guessing but maybe look up hms and see if anything else seems to fit

Juvenile arthritis? Mine started at 9. The hips are deep joints so it can be hard to detect inflammation (more obvious on wrists, knees etc). Leg pain could be referred from the hip. He should see a rheumatologist I would think. It is an auto-immune condition so that would also fit with him being generally run down.

Forgot to say - X-ray would not show inflammatory arthritis to start with, you have to have some damage before it really shows up. Ultrasound can show active inflammation earlier on in the disease, though I'm not sure they can ultrasound hips. He should have blood tests too to look for various markers of inflammation.

That is really helpful, I will ask my friend if they ran bloods. She said they had said it wasn't juvenile arthritis, but I am not sure if that was just going by the x rays. I will suggest she looks at hypermobility syndrome. So that is two things that she can check. She wants to be armed with as much info as possible as she hasn't even had an appointment through yet. She is getting increasingly anxious about him as it has been going on so long. She was reluctant to post herself in case someone raised an issue that might give her a big fright, when the appointment isn't in sight yet. So I offered to read all the posts, condense the info, or give her a rough idea of what is being suggested, and then she can read through the thread herself. The x-ray dept where he was seen has a really bad reputation, which is fuelling her worry, in case something has been missed. Thanks for all the posts so far.

Bone infection? Or tendon/muscle inflammation? One if my friends had a bone infection in her hip, took them ages to diagnose it

Juvenile arthritis is a possibility. Mine presented as a child/teenager as fairly diffuse pains in my knees, hips and legs. In fact, the first signs of the kind of arthritis I have in adults tends to be a generalised pain in the arse!

It's actually really hard to diagnose juvenile arthritis. I saw rheumatologists a on and off throughout my childhood and never really got anywhere. It wasn't until I was 30 that they managed to diagnose me and that was despite what blood tests etc indicated rather than because of it. Then when I told my mum she said, 'oh I remember the doctors saying something about ankylosing spondylitis when you were a child' but they couldn't decide on anything.

Suggest she requests to go to a different x-ray department for a second opinion. I'm sure that is possible.

There are lots of things that can produce pain and a limp, and I think particularly common in boys of around that age. The concern, I would say, is the length of time it has been going on, which removes some of the possibilities-for example I don't think the virus several small boys I know had lasts that long.

The struggling at the end of the day implies to me that it is made worse by walking round on it. Tendon/ligament/muscle problems-I don't know how they can tell those, scan? I wonder if it could be a back problem? Slipped disk, or trapped nerves? Is it worse when carrying things? In some ways it doesn't sound dissimilar from really bad siatica. Does ibroprofin help?

Yes like calamitously I had lots of different diagnoses in childhood, it's a complicated area. I have quite straightforward rheumatoid arthritis now but that was only finally clear in my late 20s. I too was wondering about ankylosing spondylitis because it tends to effect the bigger rather than smaller joints and also is more common in boys/men than in women/girls, unlike most other kinds. OP do reassure your friend that despite the experiences of myself and calamitously juvenile arthritis can now usually be v well controlled with a good prognosis and often goes into remission at adolescence with no long-term problems. If he was my DS I'd want him to see a rheumatologist though, especially as it's been a while.

He sometimes has Calpol, I will ask if Ibuprofen helps. The consultant seemed surprised that she was reluctant to give him pain medication whenever he was in pain, but she can't do that as he would be having painkillers daily. Lots of interesting points raised - I went through it all with her before posting, to be as clear as possible, but there were things that I hadn't thought of, such as "Is it worse when carrying things?"

cola- it is in both legs, and both hips. He doesn't limp on one limp, just finds the pain makes it hard to walk, especially at the end of the day. She is obviously worried that it might be something very serious that they have missed, mainly as it has been going on so long. He is a lovely little boy, he is a friend of my dd1, and it is upsetting to think of him struggling on like this.

I agree that he should probably see a rheumatologist now, as several of you have suggested.

I have given my friend a rough appraisal of the thread and she is going to read through it when she gets the chance. Apparently the GP and other Doc checked him for hypermobility and he was fine as far as that went. There is something I didn't mentionn though, he is relatively inflexible for a younger child, he can't easily bend and touch his toes for instance.
Also, surprisingly he mananged to get through sports day without any issues, and the following couple of days were the best he has been in ages, but then some days he will be in pain as soon as he wakes. I had thought it was always worst at the end of the day, but it is more random than that, and quite variable.
He doesn't have problems carrying things btw, that doesn't seem to trigger more pain.

Mum of an arthritis kid here. Suggest an MRI X-ray won't show up inflammation but MRI will.

My dd was diagnosed with enthesitis related arthritis after an MRI scan. All the tendon end inflame.

Keep him mobile. Swimming will relieve pain and strengthen muscles.

Get referral to paeds.

I will suggest she asks for an MRI. Would he need to be knocked out for that?