Musculoskeletal Complaints in Children Recounted

Musculoskeletal complaints in childhood occur more frequently in the lower extremities than in the upper extremities.

A large amount of nontraumatic low intensity complaints in these patients do not reach the threshold for consultation.

Signe Fuglkjær and colleagues at the University of Southern Denmark noted that gaining an overview of musculoskeletal extremity complaints in childhood is difficult but essential to developing evidence-based prevention and treatment strategies.

In this systematic review, they aimed to describe the prevalence and incidence of musculoskeletal extremity complaints in children and adolescents in both general and clinical populations in relation to age, anatomic site, and mode of onset.

The authors searched MEDLINE and EMBASE electronically, assessed the risk of bias, and individually performed data extraction.

A total of 19 general population studies and 3 clinical population studies were included, with children aged 0 to 19 years. For most of the analyses, they used a division between younger children (aged 0 to 12 years) and older children (aged 10 to 19 years).

The researchers reported their findings in BMC Musculoskeletal Disorders.

Following are some of the results:

• Lower extremity complaints were more common than upper extremity complaints regardless of age and type of population; the most frequent pain site changed from ankle/foot in the youngest to knee in the oldest.

• About twice as many nontraumatic as traumatic complaints occurred in the lower extremities. The opposite relationship was found for the upper extremities in the general population studies.

• Relatively more lower extremity complaints were seen in the general population studies than in the clinical population studies.

• In general population studies, wrist/hand/fingers was the most common site of upper extremity complaint in younger children and shoulder complaints were more common among older children.

• In clinical population studies, wrist/hand/fingers was the most common site in both age groups.

• In the younger children, 3 of the general population studies classified the complaints of the lower extremities into traumatic or nontraumatic mode of onset. All 3 reported about 2 times more nontraumatic complaints than traumatic complaints.

• No pattern of differences in reporting between studies of high and low risk of bias was seen.

“Musculoskeletal problems in childhood might not only lead to musculoskeletal complaints in adulthood, but could also be a barrier for physical activity and thus have a negative influence on general health,” the authors noted. “The amount of physical activity in childhood is considered to be a predictor of the amount of physical activity in adults, which is important in prevention of many lifestyle disorders, e.g. diabetes and cardiovascular disease.”

They added, “Future research should use standardised and validated outcome measures and investigate the possible consequences of the low intensity complaints in large longitudinal cohorts to establish if there is a potential for prevention of long-term sequelae through early detection and intervention.”

References:

Fuglkjær S, Dissing KB, Hestbæk L. “Prevalence and incidence of musculoskeletal extremity complaints in children and adolescents. A systematic review.” BMC Musculoskelet Disord. 2017 Oct 18;18(1):418. doi: 10.1186/s12891-017-1771-1772.