Juvenile Idiopathic Arthritis for the Pediatric Orthopedic Surgeon.

Juvenile idiopathic arthritis includes conditions characterized by joint inflammation of unknown etiology lasting longer than 6 weeks in patients younger than 16 years. Diagnosis and medical management are complex and best coordinated by a pediatric rheumatologist. The mainstay of therapy is anti-inflammatory and biologic medications to control pain and joint inflammation. Orthopedic surgical treatment may be indicated for deformity, limb length inequality, or end-stage arthritis. Evaluation of the cervical spine and appropriate medication management in consultation with a patient's rheumatologist are essential in perioperative care. Preoperative planning should take into account patient deformity, contracture, small size, osteopenia, and medical comorbidities.

Musculoskeletal diagnosis in adolescents.

Musculoskeletal complaints are a common reason for adolescents to seek medical attention. It is estimated that musculoskeletal problems account for up to 20% of visits to primary care practitioners. Many studies have shown the inadequacies of training of medical students and primary care residents in musculoskeletal medicine. Also, many practitioners do not feel comfortable in the management of common problems in this area. A general outline for approaching adolescents with musculoskeletal complaints is presented in this article and is not unlike the approach to other clinical problems. This outline follows the logical exploration of the medical history followed by physical examination and formulation of the appropriate differential diagnosis. The broad categories of conditions that should be considered in the differential diagnosis of musculoskeletal symptoms include rheumatic diseases, chronic pain syndromes, systemic vasculitides, infections, overuse syndromes, specific orthopedic conditions, metabolic bone disease, neoplasms of connective tissue and bone, psychosomatic disorders, peripheral neuropathy, and primary muscle disease.