Presentations
- Acrocyanosis
- Allodynia
- Back pain
- Flat feet
- Generalised hypermobility
- Hyperalgesia
- Leg length discrepancy
- Limp
- Musculoskeletal pain that limits function
- Regional musculoskeletal pain, chronic
- Restriction in movement in axial or peripheral joints
- Symptoms of pain sensitisation / amplification
- Widespread musculoskeletal pain, chronic
Conditions
- Acrocyanosis
- Chilblains
- Growing pains
- Hereditary connective tissue disorders, such as:
- Ehlers–Danlos syndrome
- Marfan syndrome
- Joint hypermobility, and syndromes associated with joint hypermobility
- Pain amplification syndromes, including:
- chronic widespread pain syndrome
- complex regional pain syndromes (CRPS)
- secondary pain sensitisation
- Regional biomechanical conditions (including, but not limited to):
- ankle, such as tarsal coalition
- apophysitis syndromes, such as:
- Osgood–Schlatter disease
- Sever’s disease
- hips:
- Perthes disease
- slipped upper femoral epiphysis (SUFE)
- knees:
- hoffa pad impingement syndrome
- patellofemoral pain
- osteochondritis dissecans lesions
- pes planus
- spine:
- discitis
- scoliosis
- spondylosis / spondylolisthesis
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigation
- consider the impact of illness and disease on patients and families, and their quality of life
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Conditions
- Endocrine disorders, such as diabetic cheiroarthropathy
- Inborn errors of immunity, such as:
- antibody deficiency
- combined immunodeficiency
- Malignancy, such as:
- Metabolic disorders, such as mucopolysaccharidoses
- Musculoskeletal manifestations of other systemic disease
- Skeletal dysplasia
- Vitamin deficiency, such as:
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigation
- consider the impact of illness and disease on patients and families, and their quality of life
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- Common ages of presentation of biomechanical conditions, such as Perthes disease versus slipped upper femoral epiphysis (SUFE)
- Hypermobility across the age spectrum
- Musculoskeletal anatomy
- Pathophysiology of pain, and potential psychosocial factors as a complex interaction of signals of:
- central nervous system (CNS)
- neuropathic
- nociceptive
- Sex ratios of listed conditions, including pain amplification syndromes
- Applicability of hypermobility scores, such as the Beighton score, in paediatrics
- Appropriate imaging modalities to diagnose or exclude specific conditions
- Autoantibody testing, blood tests, and inflammatory markers
- Clinical assessment to rationalise investigations, with an awareness of the challenges of false positives and over-investigating, weighed against the risk of missing organic pathology
- Genetic testing for relevant conditions such as Ehlers–Danlos syndrome
- Interpretation of metabolic screening, such as urine glucose aminoglycans, as relevant
Therapeutics and management principles
- Educating patients and families regarding musculoskeletal pain
- Evidence-based approach to management of symptoms and disease through:
- addressing psychosocial contributors
- aids / braces / splints, as required
- allied health input
- awareness of available therapeutics for treating chronic pain
- awareness of interventional pain procedures, such as nerve blocks
- non-pharmacological and pharmacological approaches
- Exercise
- Healthy eating
- Lifestyle modification, including sleep hygiene
- The role of multidisciplinary input, such as:
- occupational therapist
- physiotherapy
- psychologist
- school liaison
- Awareness of potential mimics of arthritis and other rheumatic conditions
- Impact of chronic musculoskeletal pain (of any nature) on the child and family
- Management of patient expectations in clinic, such as further investigations or curative medications, in patients with pain
- Patient advocacy, such as letters of support for school
