Musculoskeletal pain in primary pediatric care: Analysis of 1000 consecutive general pediatric clinic visits

Objectives. 1) To determine the number of primary care clinic visits attributable to musculoskeletal pain (MSP) in children greater than or equal to 3 and <15 years of age. 2) To describe the demographic characteristics of this population assessed for limb/back pain. 3) To characterize the etiology of musculoskeletal pain in an urban general pediatric clinic in Madrid, Spain. Methods. Prospective evaluation of 1000 consecutive clinic visits to an urban general pediatric clinic. Inclusion criteria were 1) age greater than or equal to 3 and <15 years and 2) musculoskeletal evaluation requested by the family or patient. All consultations related to MSP were recorded via standard protocol and data record form. Results. During the study period, 61 of 1000 (6.1%; confidence interval: 4.6-7.5) clinic visits for children greater than or equal to 3 and <15 years were related to MSP. Patients' age, mean +/- SD, was 9.7 +/- 3.3 years. Musculoskeletal complaints were more frequent in boys (57.4%), although there was no statistical difference. The presenting complaints included knee arthralgias in 33%; other joint leg, ankles, wrists, elbows) arthralgias in 28%; soft tissue pain in 18%; heel pain in 8%; hip pain in 6%; and back pain in 6%. Symptoms were attributable to trauma in 30%; overuse syndromes in 28% leg, chondromalacia patellae, mechanical plantar fasciitis, overuse muscle pain); and normal skeletal growth variants (eg, Osgood-Schlatter syndrome, hypermobility, Sever's disease) in 18% of patients. Conclusion. MSP represents a frequent presenting complaint in general pediatric practice. A new heightened awareness of the frequent occurrence of MSP should be adopted when designing pediatrics continuing medical education and training programs.