It's not Just Growing Pains: A Guide to Childhood Muscle, Bone, and Joint Pain, Rheumatic Diseases, and the Latest Treatments

By Thomas J. A. Lehman | Go to book overview

24
Understanding
Laboratory and
Diagnostic Tests

X RAYS

Each type of diagnostic test has its proper place in evaluating children with muscle, bone, or joint pain. If a bone is painful, it is appropriate to begin the evaluation (after a complete history is taken and a thorough physical examination is done) with an X-ray radiograph to eliminate the possibility of fracture or structural abnormality. X rays are also useful to determine whether bones are out of alignment or abnormally curved. An X ray may be the only study necessary to establish the diagnosis of a broken bone, slipped capital femoral epiphysis, scoliosis, or many other orthopedic conditions (see Chapter 3). However, for children with juvenile arthritis, lupus, or many other rheumatic conditions, the X ray may be useful only to exclude orthopedic problems.

X rays are almost always necessary when there is any history of trauma before the onset of pain or when there has been a sudden change in the child’s condition. However, the bones are not fully calcified in young children, and the use of X rays to evaluate arthritis is of little value except in the most severe cases. Once the initial X rays have been done, follow up X rays are necessary only if a fracture is suspected or if there is a structural abnormality that must be monitored. For children with rheumatic disease, periodic X rays provide little information that cannot be gained from careful examination of the joints and their range of motion. However, X rays are important if there is a sudden change or if the problem is not resolving in the expected manner.

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