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Widespread Pain

A 10 year old girl presents with her mother with a 4 week history of aches in her legs, especially around her knees after exercise.

Otherwise she is well and not limited by her symptoms.

Her GP notes that she looks well and has some bruising to her shins. She has hypermobile joints noted on pGALS examination. She has some scars over her knees from mild injuries in the past but these have healed normally.

Otherwise examination was normal with no lymphadenopathy, and her abdomen is soft and non-tender.  

What is the differential diagnosis?

The differential diagnosis includes causes of aches and pains in children and must exclude malignancy, metabolic cause (hypothyroidism, osteomalacia) and inflammatory muscle disease.

Investigations include:

  • Blood tests and acute phase reactants (all normal).
  • Muscle enzymes, thyroid function and bone chemistry and vitamin D levels (all normal).
What is the diagnosis and what are the management approaches ?

The likely diagnosis is hypermobility related pain and there are no features to suggest inherited collagen disorders such as Marfan's syndrome.

Management includes:

  • Reassurance and advice about hypermobility (see below)
  • Advice on footwear and onward referral to Orthotics/Podiatry if appropriate
  • Referral to physiotherapy for pain management strategies, review of balance, muscle strength