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Distinguishing Inflammatory from Mechanical Features

The history needs to explore the concerns and observations made by the parent / carer or child. You will need to use open probing questions. The history may be vague but it is helpful to consider features that may help discern if this is an inflammatory problem or not and whether there are any red flag features.

Pain Yes, but may not be verbally expressed, particularly in younger children (below 4 years). May manifest as change of mood or avoidance of activities. Usually a predominant feature.         Rarely, pain in calves
(Effect of movement) Relationship to activity Movement may ease symptoms, inactivity may cause gelling. Usually worse with and after activity. Reduced endurance, may complain of pain in legs after activity
Morning stiffness Present. Important to ask about dressing, behaviour and activities in the mornings. Stiffness may manifest as 'gelling' after periods of rest (eg difficulty getting up from sitting on the floor). Usually absent.  Absent
Swelling Yes and usually persistent. Usually worse with, and after activity. Calf hypertrophy (overdeveloped calf muscles, out of proportion with rest of body)
Locking Usually absent. May be present. Absent
Giving way Usually absent. May be present.  May be present
Worst time of day Usually mornings. Often after school or evening. Mornings can be worse after activity
Restriction of movement Often present, can be profound. May be present. May have ankle tightness

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