Shoulders, Elbows & Knees
Common Pain & Injuries We Treat
The SLUCare Physician Group pediatric orthopedists at SSM Health Cardinal Glennon Children’s Hospital are experts in diagnosing and treating joint injuries and pain, including pain in the shoulders, elbows, and knees.
There are many reasons a child may experience joint pain. It may be due to a muscle or ligament strain, abnormal rotation or alignment of joints, limited flexibility, over-use or improper form during physical activities, or a traumatic injury. It also can be caused by another medical condition such as juvenile arthritis.
If your child’s pain is sudden or severe, lasts longer than two weeks, or if he or she has been injured during an activity, an appointment with an orthopedist is recommended to evaluate and determine the cause of the pain.
Growing Pains
“Growing pains” is a phrase used to describe an aching feeling or cramping in a child’s legs that typically occurs only late in the day or at night. The pain is felt most often behind the knees, but also can occur in the calves, shins, or thighs. It affects both legs and may keep your child restless and awake at night if the pain lasts for several hours. In some children, the pain lasts just a few minutes or can disappear for days or weeks at a time.
While the name assumes that the pain is the result of growth spurts as children age, there is no evidence confirming that. It may be the result of lots of physical activity during the day or it may be due to joint and muscle stiffness. If there is no other underlying medical issue, the pain or discomfort should stop by the time your child is a teenager. In the interim, your doctor may suggest physical therapy or various activities to stretch the muscles. Heat, such as with a heating pad or warm bath, often helps. Over-the-counter pain medications also may be suggested for short-term use. If the pain becomes severe, or if there is swelling or inflammation, or your child starts limping, see a doctor.
Shoulders
Shoulder Dislocation & Instability
According to the Pediatric Orthopedic Society of North American, 20% of all shoulder dislocations occur in children less than 20 years of age. That may be due to the increased participation in sports activities at younger ages. Athletes in sports such as gymnastics, hockey, basketball, skiing, football are more at risk.
Shoulder dislocations occur when the top of the arm bone — the ball — separates from the shoulder socket. And once it occurs, the risk is high that a child will have repeated dislocations. The type of dislocation is named by how it occurs. If the top of the arm bone is pushed forward with a sudden force, it is called an anterior dislocation. If the bone is pushed backwards, it’s called posterior dislocation. The sudden movement of bone can cause pain and tingling that can travel down the arm or around the neck. A child may also be unable to move the arm.
If you suspect a shoulder dislocation, doctors will order imaging tests to look at the bones and tissues of the shoulder. A MRI may also be ordered to check for ligament damage.
Treatment options range from restricting movement and rotation for up to six weeks and/or physical therapy to strengthen the muscles and maintain range of motion. With a severe or chronic dislocation, a surgical procedure may be recommended. Because the risk of recurrence is high, attention to a rigorous shoulder strengthening program is important following surgery or rest after the initial injury.
Glenohumeral Internal Rotation Deficit (GIRD)
GIRD is a loss of internal rotation in the ball and socket of the shoulder joint. It is often caused by repetitive throwing and is a condition that can worsen over time. Non-surgical treatment is often the first step, with physical therapy focused on stretching and strengthening the muscles in the joint. Throwers diagnosed with GIRD are at an increased risk for also developing a SLAP (superior labrum anterior posterior) tear, or a tear in the muscle tissue located at the top of the shoulder. This can result in a clicking sensation in the shoulder and is quite painful. In these cases, surgery is usually required, as the muscle tissue does not heal on its own.
Elbows
Elbow UCL Tears
The ulnar collateral ligament (UCL) is the primary ligament that stabilizes the elbow joint during a throwing movement. A UCL tear is caused by either a sudden injury or from repeated stress. In fact, a UCL tear is the most common injury in baseball pitchers. Initial symptoms may be a numbness or tingling in the fingers as well as pain during throwing. A popping or grinding sensation also may be felt.
Partial tears can be treated with rest, medications, and physical therapy. If the UCL is torn completely, however, reconstruction surgery, called Tommy John surgery, may be recommended. In this procedure, a tendon is removed from another place in the body and then used to replace the torn UCL. Recovery after such a procedure may take a year or longer.
Osteochondritis dissecans (OCD)
This is a condition that can develop in the elbow joint because of repeated trauma. It is most often seen in children ages 12 to 16 who participate in throwing sports or upper extremity weight-bearing activities, such as in baseball or gymnastics. Such OCD lesions also can occur in the knees or ankles. For young children, conservative treatment is recommended, such as restricted activity and therapy. For children who have finished growing and who have not benefited from conservative treatment, a minimally invasive procedure to clear out debris in the elbow and sometimes to replace cartilage in the joint may be recommended.
Knees
It’s quite common for children to have pain in the knees at times. Pain behind the joint may be related to what is typically called “growing pains.” Knee problems also occur when there is an abnormal rotation or angle between the upper and lower leg bones. But there are medical conditions that can cause pain as well as serious injuries to the knees that should be evaluated by a pediatric orthopedist.
Osgood-Schlatter’s Disease
Osgood-Schlatter's Disease is one of the most common causes of knee pain in adolescents. It is a swelling and inflammation of the growth plate at the top of the shin bone, just under the knee. It typically occurs when children are experiencing growth spurts, between the ages of 10 and 14. As a result of repeated stress on tendons, the body can form a bony bump just below the kneecap, which may or may not interfere with activities. It can become painful particularly when children participate in active supports that involve running or jumping. The good news is that rest, anti-inflammatory medications, and stretching exercises can help alleviate the problem, which goes away as a child ages. In rare cases, the boney bump that forms may need to be removed if pain persists, but otherwise it can be left alone through adulthood.
Sinding-Larsen Johansson (SLJ) Syndrome
Similar to Osgood-Schlatter’s Disease, this is an over-use injury that is caused by repeated stress. Instead of at the top of the shin bone, pain from SLJ Syndrome occurs just below the kneecap. Children usually outgrow the pain and swelling that occurs. Rest and physical therapy are important for a good recovery and to prevent further injury.
Bursitis
This is a painful swelling that occurs in small, fluid-filled sacs called bursae that cushion tendons, ligaments, and muscles around joints. There are more than 150 bursae sacs in the human body, located in the hips, shoulders, elbows, knees, ankles, thighs, and buttocks. Severe bursitis can limit movement and cause sharp pains. Ice and rest can alleviate most symptoms. Doctors may recommend pain relievers or steroids for prolonged pain and discomfort.
Dislocated Kneecap (Patellar Dislocation)
Dislocated kneecaps are common in young athletes. A rapid change in direction or a direct hit can cause the kneecap to move out of alignment, leading to pain and swelling. In some cases, the ligaments surrounding the kneecap will tear. Pieces of cartilage or bone also may break off into the joint and need to be removed with a minimally invasive surgery.
Ligament Tears
Up to one-third of all knee injuries in children are the result of torn ligaments. Tears can be partial or full and can happen in any of the four ligaments that surround and stabilize the knee:
- Anterior Cruciate Ligament (ACL)
- Medial Collateral Ligament (MCL)
- Posterior Cruciate Ligament (PCL)
- Lateral Collateral Ligament (LCL)
Physeal-Sparing Surgery
At SSM Health Cardinal Glennon Children’s Hospital, our pediatric orthopedists are experienced at treating ligament tears. In young children, a specialized surgery can repair these tears while also preserving the physeal, or growth plates, that are in the bones surrounding the knee joint. Leaving the growth plates undamaged is critical to avoid the risk of future complications, such as growth disturbances, angular changes, or even leg length abnormalities. The surgery is performed primarily to replace a torn ACL. During the procedure, the surgeon replaces a torn ligament with a small strip of tissue removed from the IT band, which runs along the outside of the leg from the hip to the knee.