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Orthopedic Conditions

This is a sample of some of the common conditions we treat at Connecticut Children’s Division of Orthopedics.

Bone Endings

Osteochondroma is the most common type of benign (non-cancerous) bone tumor in children. There are often no symptoms, so your child may only discover the osteochondroma when they notice a bump or pain.

What are the signs and symptoms of osteochondroma?

  • Hard, painless mass
  • Differing limb lengths
  • Growth disturbances (i.e., below average height)
  • Joint and muscle pain
  • Muscle weakness caused by nerve compression

Please note that pain can occur if the mass becomes inflamed. This happens when nearby muscles or tissues make contact with the osteochondroma.

What causes osteochondroma?

The cause of osteochondroma is currently unknown. A study is testing the theory that genetic abnormalities may be the cause.

How is osteochondroma diagnosed?

In most cases, doctors can diagnose an osteochondroma using x-rays.

How is osteochondroma treated?

In most cases, treatment is not needed following a diagnosis.

However, your child may need surgery if the mass causes pain, restricts movement or affects growth. Doctors at Connecticut Children’s can determine the right plan if your child requires treatment for an osteochondroma.

Fibrous Tumors

Non-ossifying fibromas are the most common benign bone lesions in children. Made of fibrous tissue, NOF are non-aggressive. They often occur in the femur (thigh bone) or tibia (shin bone), but may also occur in the humerus (upper arm bone).

What are the signs and symptoms of a non-ossifying fibroma?

  • Mild swelling or soreness
  • Dull ache, even during periods of inactivity
  • Broken bone caused, in part, by the non-ossifying fibroma; cause is usually discovered later

What causes a non-ossifying fibroma?

The cause of non-ossifying fibromas is currently unknown.

How is a non-ossifying fibroma diagnosed?

  • Physical exam
  • X-rays
  • Additional imaging if necessary:
    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT) scan

How is a non-ossifying fibroma treated?

In most cases, treatment is not needed for non-ossifying fibromas.

However, treatment may be necessary if the non-ossifying fibroma contributes to a weak or fractured bone. In these cases, providers treat the injury by stabilizing the bone. Doctors at Connecticut Children’s can determine the right plan to treat your child’s condition.

Shoulder

The shoulder is the most versatile joint in the body but can become dislocated with force or trauma. Dislocation is often caused when the ball of the humerus rolls out of place. It can also occur when landing to break a fall or taking a direct blow to the shoulder.

What are the signs and symptoms of a dislocated shoulder?

  • Pain
  • Swelling
  • Bruising or redness
  • Difficulty moving injured area
  • Numbness or weakness at the injury site

What causes shoulder dislocation?

  • Trauma from sports injuries, with the most common from:
    • Contact sports (e.g., football, hockey, martial arts)
    • Sports that involve falling (e.g., gymnastics, cheerleading, volleyball)
  • Accidents, including traffic/car accidents
  • Falling on a shoulder or outreached arm
  • Muscle contractions caused by seizures or shock

How is a dislocated shoulder diagnosed?

  • Physical exam
  • Imaging if necessary:
    • X-rays
    • Magnetic resonance imaging (MRI)

How is a dislocated shoulder treated?

Treatment depends on the extent of your child’s injury. There are several non-surgical options to treat a dislocated shoulder:

  • I.C.E. – Rest, ice, compression and elevation
  • Activity modification or restriction
  • Pain-relief medication (e.g., acetaminophen)
  • Splint, cast or sling
  • Physical therapy

Surgery is only necessary in more severe cases. Doctors at Connecticut Children’s can determine the right plan to treat your child’s dislocated shoulder.

Click here to learn more about infant brachial plexus injuries and treatment options at Connecticut Children’s.

Arm & Elbow

Nursemaid’s elbow is when the radius (forearm bone) slips out of place from where it attaches in the elbow. The medical name for nursemaid’s elbow is radial head subluxation. Other terms for radial head subluxation are a dislocated elbow, slipped elbow or “toddler’s elbow.” This condition is most common in children between age 1-4, and rarely seen in children older than 6 years old.

Nursemaid’s elbow is temporary and leaves no permanent damage. Once a child sustains this type of injury, it is more likely to occur again.

What are the signs and symptoms of nursemaid’s elbow?

  • Immediate pain in the injured arm
  • Refusal to use the affected limb
  • Pain in the affected elbow, along with pain in the wrist and/or shoulder
  • Anxiety (due to sudden pain)

What causes nursemaid’s elbow?

  • Lifting or swinging a child by the hand
  • Pulling a child’s arm through a jacket sleeve
  • Catching a child by the hand to prevent a fall
  • Infants rolling themselves over

Please note that these are just a few examples. Nursemaid’s elbow can be caused by any sudden pulling on a child’s arm.

How is nursemaid’s elbow diagnosed?

  • Physical exam
  • Imaging when necessary
    • X-rays
    • Ultrasound

If you suspect your child has an injury such as a nursemaid’s elbow, call their doctor immediately or take them to the emergency department.

How is nursemaid’s elbow treated?

Treatment depends on the extent of your child’s injury. There are several non-surgical options to treat nursemaid’s elbow:

  • Pain-relief medication (e.g., acetaminophen)
  • Reassurance for the child
  • Gently moving bones back into normal position

Doctors at Connecticut Children’s can determine the right plan to treat your child’s injury.

Lateral epicondylitis is often referred to as “tennis elbow.” It is an overuse injury to the tendons that attach the forearm muscles to the outer part of the elbow.

Tennis elbow is not common in children or teens but can occur in this group with repetitive activity. This is most often seen in young patients who play tennis or other racquet sports.

What are the signs and symptoms of tennis elbow?

  • Pain with wrist extension
  • Pain with grip or holding
  • Decreased grip strength
  • Forearm weakness

What causes tennis elbow?

Tennis elbow is the result of repetitive stress/repeated activity. Causes include playing certain sports, painting or using some tools.

How is tennis elbow diagnosed?

  • Physical exam
  • X-rays if necessary

How is tennis elbow treated?

Treatment depends on the extent of your child’s injury. There are several non-surgical treatment options to treat tennis elbow:

  • I.C.E. – Rest, ice, compression and elevation
  • Activity modification or restriction
  • Anti-inflammatory medication (e.g., ibuprofen)
  • Stretching and strengthening exercises
  • Elbow strap for support

Doctors at Connecticut Children’s can determine the right plan to treat your child’s injury.

Bursitis is the pain and swelling of bursa—small sacs of fluid that help joints move. Elbow bursitis, also known as olecranon bursitis, affects the boney tip of the elbow. This condition is more common in adults than children.

What are the signs and symptoms of elbow bursitis?

  • Swelling
  • Pain (often worsened with pressure)
  • Redness, warm to the touch

What causes elbow bursitis?

  • Trauma (e.g., a hard blow to the elbow)
  • Prolonged pressure (e.g., leaning on the tip of the elbow for long periods)
    • Develops over several months

How is elbow bursitis diagnosed?

  • Physical exam
  • X-rays if necessary
  • Possible fluid testing

How is elbow bursitis treated?

Treatment depends on the extent of your child’s injury. There are several non-surgical options to treat elbow bursitis:

  • I.C.E. – Rest, ice, compression and elevation
  • Activity modification or restriction
  • Anti-inflammatory medication (e.g., ibuprofen)
  • Antibiotics if needed
  • Elbow pads
  • Needle aspiration

Surgery is only necessary in more severe or complicated cases. Doctors at Connecticut Children’s can determine the right plan to treat your child’s elbow bursitis.

Cubital tunnel syndrome occurs when the elbow’s ulnar nerve becomes compressed or irritated. The area of the elbow’s ulnar nerve is often referred to as the “funny bone.” Ulnar nerve compression at the elbow could cause numbness or tingling in the hand and/or fingers.

While this condition is less common in children and teens, it does occur and can lead to complications in motor skill development. Left untreated, cubital tunnel syndrome can also lead to muscle wasting in the hand.

What are the signs and symptoms of cubital tunnel syndrome?

  • Numbness and tingling (especially in the ring and little fingers)
  • Pain in the affected area
  • Weakened grip
  • Poor finger coordination

Please note that symptoms of cubital tunnel syndrome may resemble other conditions. It is important your child sees their provider for a diagnosis.

What causes cubital tunnel syndrome?

The exact cause of cubital tunnel syndrome is unknown, but there are several contributing factors:

  • Keeping the elbow bent for long periods
  • Leaning on the elbow for long periods
  • Bending the elbow often
  • A direct blow or injury to the elbow
  • Fluid buildup in the affected area

How is cubital tunnel syndrome diagnosed?

  • Physical exam
  • Additional diagnostic testing if necessary:
    • Nerve conduction test
    • Electromyogram (EMG) test
    • X-rays

How is cubital tunnel syndrome treated?

Treatment depends on the extent of your child’s condition. There are several non-surgical options to treat cubital tunnel syndrome:

  • I.C.E. – Rest, ice, compression and elevation
  • Activity modification or restriction
  • Anti-inflammatory medication (e.g., ibuprofen)
  • Splint or brace
  • Physical therapy
  • Steroid injections

Surgery is only necessary in more severe cases if other treatments are ineffective. Doctors at Connecticut Children’s can determine the right plan to treat your child’s cubital tunnel syndrome.

Click here to learn more about arm limb-length discrepancy and treatment options at Connecticut Children’s.

Hand, Wrist & Finger

The brachial plexus is a network of nerves between the neck and shoulders. These nerves provide feeling and muscle control in the shoulder, arm, hand and fingers. If stretched, compressed or torn, brachial plexus injuries can occur.

Brachial plexus injuries can occur in patients of all ages, including infants. Difficult deliveries may stretch, compress or even tear the brachial plexus nerves. These injuries may affect all or part of the brachial plexus.

There are different types of brachial plexus injuries. They are often categorized according to the type of nerve injury. Brachial plexus birth palsy is also called Erb’s palsy.

Patient Stories

What are the signs and symptoms of an infant brachial plexus injury?

  • Full or partial lack of movement
  • Muscle weakness or paralysis in the affected area
  • Decreased movement or sensation in the affected area
  • An odd position of the affected limb (e.g., arm hanging limp)

What causes infant brachial plexus injuries?

Several things can cause infant brachial plexus injuries, including:

  • Breech delivery
  • Large gestational size
  • Pregnancy with twins or multiples
  • Prolonged or difficult labor
  • Vacuum- or forceps-assisted delivery

How is an infant brachial plexus injury diagnosed?

  • Physical exam
  • Imaging if necessary
    • X-rays
    • Ultrasound
    • Magnetic resonance imaging (MRI)
  • Additional testing if necessary
    • Electromyogram (EMG)
    • Nerve conduction study (NCS)

How is an infant brachial plexus injury treated?

Many newborns with brachial plexus injuries at birth recover on their own. Your infant’s doctor will routinely re-examine them to check on nerve recovery. (It can take up to two years for complete recovery.)

If the injury is more complicated or does not resolve on its own, other treatment may be necessary. Treatment depends on the type and extent of your child’s injury. There are several surgical and non-surgical options to treat brachial plexus injuries:

 

NON-SURGICAL

  • Daily physical therapy
  • Range-of-motion exercises

SURGICAL

  • Microsurgery (e.g., nerve graft or nerve transfer)
  • Release of joint contracture
  • Tendon transfer

Doctors at Connecticut Children’s can determine the right plan to treat your child’s injury.

Syndactyly is a condition where children are born with fused or webbed fingers. About half of the children born with this condition have it in both hands. This is known as bilateral syndactyly.

There are three types of syndactyly: Simple, complex and complicated. Simple syndactyly occurs when skin and soft tissue conjoin fingers. Complex syndactyly occurs when underlying bones have joined together. Complicated syndactyly occurs when the fingers have extra bones and abnormal tendons/ligaments.

While this condition most often occurs in the fingers, syndactyly can also affect the toes.

Patient Stories

What are the signs and symptoms of syndactyly?

The signs differ depending on the type of syndactyly a child has:

SIMPLE SYNDACTYLY

  • Fingers conjoined by skin and soft tissue only

COMPLEX SYNDACTYLY

  • Underlying bones joined together

COMPLICATED SYNDACTYLY

  • Extra bones in the affected hand/fingers
  • Abnormal tendon and/or ligament development

What causes syndactyly?

During the gestation period, a baby’s hands form in the shape of a paddle. As they continue to develop in the womb, their fingers split into separate fingers. This happens around the sixth to eighth week of pregnancy. If two or more fingers do not separate during this time, syndactyly occurs.

This condition often runs in families. About 10-40% of children with syndactyly inherit it from their parents. In some cases, syndactyly is part of a genetic syndrome (e.g., Poland syndrome or Apert syndrome).

How is syndactyly diagnosed?

Syndactyly is often diagnosed at birth. Prenatal ultrasounds can sometimes detect the condition earlier.

Sometimes an infant’s doctor will use x-rays to determine the structure of a baby’s fingers. This can help determine the type of syndactyly and course of treatment.

How is syndactyly treated?

To treat syndactyly, your child will need surgery to separate the joined fingers. They will likely have this operation when they are between 1 and 2 years old. If your child has several fingers involved, they may need more than one surgery.

Doctors at Connecticut Children’s provide skilled treatment and aftercare for syndactyly.

De Quervain’s tenosynovitis is the painful inflammation of certain tendons in the thumb. Seen more in adults than children, the condition is sometimes called “caregiver’s wrist.”

However, activities common among children and teens can lead to de Quervain’s tenosynovitis. This has earned new nicknames for the condition: “Texter’s thumb” and “gamer’s thumb.”

Patient Stories

What are the signs and symptoms of de Quervain’s tenosynovitis?

  • Gradual or sudden onset of pain, including:
    • Pain when moving or twisting the wrist
    • Pain along the thumb side of the wrist
    • Worsening pain with use of the hand or thumb
    • Pain that travels to the thumb or from the wrist to the forearm
    • Pain or difficulty moving the thumb, especially when grasping or pinching
  • Snapping/popping sensation in the wrist with thumb movement
  • Impaired thumb function
  • Decreased grip function
  • Possible noise with wrist or thumb movement (e.g., pop, creak or crackling)

What causes de Quervain’s tenosynovitis?

  • Repetitive overuse (e.g., texting, typing or knitting)
  • Repetitive activities requiring grip and sideways wrist motion (e.g., skiing, heavy lifting or gaming)
  • Inflammatory conditions (e.g., rheumatoid arthritis)
  • Direct wrist injury

How is de Quervain’s tenosynovitis diagnosed?

In most cases, doctors can diagnose de Quervain’s tenosynovitis with a physical exam.

The test most often used for diagnosis is the Finkelstein test. It involves a series of movements to check for noticeable pain in the wrist/arm from the thumb.

How is de Quervain’s tenosynovitis treated?

Treatment depends on the extent of your child’s condition. There are several non-surgical options to treat de Quervain’s tenosynovitis:

  • I.C.E. – Rest, ice, compression and elevation
    • Heat may also be used in place of ice
  • Activity modification or restriction
  • Anti-inflammatory medication (e.g., ibuprofen)
  • Splint or brace
  • Physical therapy
  • Steroid injections

Surgery is only necessary in more severe cases if other treatment options are ineffective. Doctors at Connecticut Children’s can determine the right plan to treat your child’s de Quervain’s tenosynovitis.

Ganglion cysts are noncancerous lumps that develop in the wrists or hands. These round or oval fluid-filled cysts develop along tendons or joints. Ganglion cysts are the most common masses found in the wrist and hand. They can be small, pea-sized lumps or larger cysts around one inch in diameter.

Patient Stories

What are the signs and symptoms of a ganglion cyst?

  • Visible lump in affected area
  • Occasional pain
  • Occasional numbness

 

Please note that most ganglion cysts are painless with no symptoms aside from the visible cyst itself.

What causes ganglion cysts?

The cause of ganglion cysts is currently unknown.

How is a ganglion cyst diagnosed?

  • Physical exam
  • Imaging if necessary:
    • X-rays
    • Magnetic resonance imaging (MRI)

How are ganglion cysts treated?

Treatment is typically not needed for ganglion cysts. In most cases, the cysts go away on their own.

However, treatment may be necessary if a ganglion cyst is causing pain. In these cases, doctors may recommend a splint, needle aspiration or surgery. Doctors at Connecticut Children’s can help determine the right plan to treat your child’s condition.

Pediatric trigger thumb affects three out of every 1,000 children. It is most common in children younger than 5 years old. Although this condition is common in young children, it is not congenital.

Trigger thumb refers to a thumb that catches, locks or is otherwise stuck in a flexed position. Pediatric trigger thumb is different from trigger finger or trigger thumb in adults.

Patient Stories

What are the signs and symptoms of trigger thumb?

  • Pain
  • Swelling
  • Stiffness
  • Thumb is stuck in position
  • Possible clicking or popping

These symptoms are also associated with certain inflammatory conditions. It is important your child sees their doctor for diagnosis.

What causes trigger thumb?

Pediatric trigger thumb happens by chance. It is not related to other medical issues or injuries.

How is trigger thumb diagnosed?

Doctors can usually diagnose pediatric trigger thumb with a physical exam. X-rays are rarely necessary.

How is trigger thumb treated?

In very young children, trigger thumb may resolve on its own. This chance decreases as children get older. Surgery to correct trigger thumb is often performed when a child is between 1 and 3 years old.

It is important to treat pediatric trigger thumb to avoid long-term complications. Doctors at Connecticut Children’s can help treat your child’s condition.

Hip

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in adolescents. It occurs when the head of the femur slips off the neck of the bone at the growth plate. In most cases, it only occurs on one side.

This condition affects teens and pre-teens who are still growing. It usually develops in periods of rapid growth during puberty.

There are two types of SCFE. Approximately 90% of cases are stable. With stable SCFE, patients can put weight on the affected hip (with or without crutches). Fewer than 10% of cases are unstable, which causes sudden and severe pain. Unstable SCFE requires urgent treatment.

What are the signs and symptoms of slipped capital femoral epiphysis?

The signs and symptoms of SCFE vary depending on the extent of the child or teen’s condition:

STABLE SCFE

  • Intermittent pain in the groin, hip and/or thigh
  • Worsening pain with activity (e.g., walking or running)
  • Limping or other difficulty walking

UNSTABLE SCFE

  • Sudden onset of pain
  • Inability to put weight on the affected leg
  • Outward turning of the affected leg
  • Discrepancy in leg length

The symptoms of SCFE may resemble other conditions or problems with the hip. It is important your child sees their doctor for diagnosis.

What causes slipped capital femoral epiphysis?

The cause of SCFE is currently unknown. While the cause is unknown, there are several risk factors:

  • Obesity
  • Family history of SCFE
  • Endocrine or metabolic disorders (e.g., hypo- or hyperthyroidism)

How is slipped capital femoral epiphysis diagnosed?

  • Physical exam
  • X-rays
  • Additional imaging if necessary:
    • Magnetic resonance imaging (MRI)

How is slipped capital femoral epiphysis treated?

If your child receives a diagnosis of SCFE, they are not allowed to put weight on their hip—even if it doesn’t hurt. In most cases, SCFE patients undergo surgery within 24 to 48 hours.

It is important to treat this condition as soon as possible. Connecticut Children’s can help if you suspect your child has SCFE. Doctors at Connecticut Children’s are the only healthcare providers in the state of Connecticut that perform surgical hip dislocation and osteotomy surgeries to address this condition.

When the hip joint does not develop properly and the socket is too shallow, hip dysplasia occurs. This allows the ball to slip out of the joint.

Developmental dysplasia of the hip (DDH) is infant hip dysplasia. In adolescents and young adults, hip dysplasia is sometimes called acetabular dysplasia. Acetabular dysplasia can be a continuation of DDH.

What are the signs and symptoms of hip dysplasia?

  • Pain in the hip, thigh or knee
  • Worsening pain with activity
  • Hip joint may pop in and out of place
  • Legs may look uneven (DDH)
  • Inability to fully spread or stretch the affected leg outward

What causes hip dysplasia?

The exact cause of hip dysplasia is currently unknown. It is likely that both environmental and genetic factors play a role.

How is hip dysplasia diagnosed?

  • Physical exam
  • X-rays
  • Additional imaging if necessary:
    • Ultrasound
    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT) scan

How is hip dysplasia treated?

Treatment depends on the extent of your child’s condition. There are several non-surgical options to treat hip dysplasia:

DEVELOPMENTAL DYSPLASIA (DDH)

  • Pavlik harness
  • Abduction bracing
  • Body casting

ACETABULAR DYSPLASIA

  • Activity modification or restriction
  • Physical therapy

Surgery is only necessary in more severe or complicated cases. Connecticut Children’s can determine the right plan to treat your child’s hip dysplasia. Doctors at Connecticut Children’s are the only healthcare providers in the state of Connecticut that offer hip preservation surgeries such as periacetabular osteotomy (PAO).

Legg-Calvé-Perthes Disease (or Perthes disease) is a rare hip condition in children. It occurs when the shaped head of the thigh bone—the femoral head—loses its blood supply. This causes the femoral head to collapse. Over time, the body absorbs the dead bone and replaces it with new bone. This can lead to flattening of the ball, causing the joint to become painful and stiff.

This condition affects children between the ages 2 and 12. Most children with Perthes disease are 6-9 years old. The majority of cases only affect one hip; in 10% of cases, the condition affects both hips.

What are the signs and symptoms of Legg-Calvé-Perthes disease?

  • Pain in the hip
  • Worsening pain with activity
  • Limping
  • Possible pain in the thigh or knee area
  • Possible muscle loss in the upper leg and hip

The symptoms of Perthes disease may resemble other hip conditions or concerns. It is important your child sees their doctor for diagnosis.

What causes Legg-Calvé-Perthes disease?

The cause of Perthes disease is currently unknown.

How is Legg-Calvé-Perthes disease diagnosed?

  • Physical exam
  • Diagnostic imaging, which may include:
    • X-rays
    • Magnetic resonance imaging (MRI) with and/or without contrast dye

How is Legg-Calvé-Perthes disease treated?

Treatment depends on the extent of your child’s condition. There are several non-surgical options to treat Perthes disease:

  • Rest
  • Activity modification or restriction
  • Reduced weight-bearing with the use of crutches and/or a wheelchair
  • Physical therapy
  • Anti-inflammatory medication (e.g., ibuprofen)
  • Casting or bracing

Surgery is only necessary in more severe or complicated cases of Perthes disease. Doctors at Connecticut Children’s can determine the right plan to treat your child’s condition.

Leg & Knee

Blount’s disease is a pediatric condition affecting the growth plate around the knees. This disease causes the growth plate near the inside of the knee to slow down or stop making new bone. While this happens, the plate on the outside of the knee continues to grow at a normal rate. This results in a bowlegged appearance in one or both of a child’s legs.

There are two types of Blount’s disease. Infantile Blount’s disease appears between birth and 3 years old. It is usually bilateral—occurring in both legs. The deformity is in the tibia (shin bone) only. Adolescent Blount’s disease occurs in children 10 years and older. It usually affects one side, with the deformity occurring in both the thigh bone and tibia.

What are the signs and symptoms of Blount’s disease?

  • Bowing of one or both legs (a condition known as genu varum)
  • May cause trouble walking
  • Possible knee pain that worsens with activity (see in pre-teens and teens)

What causes Blount’s disease?

The exact cause of Blount’s disease is unknown. While the exact cause is unknown, there are several risk factors:

  • Obesity
  • Early walking
  • Possible genetic component

How is Blount’s disease diagnosed?

  • Physical exam
  • X-rays

How is Blount’s disease treated?

Treatment depends on the extent of your child’s condition. For young patients with infantile Blount’s disease, bracing can be effective. Bracing may help guide the legs into a straighter position as your child grows.

Your child’s doctor may recommend surgery if bracing is ineffective. Doctors may also recommend surgery for severe deformities. Surgical treatment options include an osteotomy or hemiepiphysiodesis.

An osteotomy involves cutting and realigning the bone. This procedure usually corrects the deformity immediately. A hemiepiphysiodesis corrects the deformity over time. Known as guided growth, this procedure gradually corrects deformity.

Doctors at Connecticut Children’s can determine the right plan to treat your child’s condition.

There are two types of pediatric knee deformities: genu varum (bowlegs) and genu valgum (knock-knees).

If a child stands straight with their feet together but their knees do not touch, they have bow-legs. If a child’s knees touch but ankles do not while standing straight, they have knock-knees.

What are the signs and symptoms of genu varum and/or genu valgum?

While these conditions do have overlap, they have different signs and symptoms:

GENU VARUM (BOWLEGS)

  • While standing straight, ankles touch or are close together while knees are apart
  • Knees curved outwards in both legs
  • May cause awkward walking pattern
  • Toes may point inward (known as “intoeing” or “pigeon-toe”)
  • Clumsiness or frequent tripping

GENU VALGUM (KNOCK-KNEES)

  • While standing, knees touch or are close together while ankles are apart
  • Knees angle inward in both legs
  • Unusual walking pattern
  • Outward rotated feet

Please note that these conditions usually do not bother young children. Genu varum and genu valgum should not cause pain or discomfort. If your child does experience pain, they may need further evaluation.

What causes genu varum or genu valgum?

There are physiologic and pathologic causes for genu varum and genu valgum:

PHYSIOLOGIC

  • Part of normal growth and development (no known cause)

PATHOLOGIC

  • Rickets disease
  • Blount’s disease
  • Skeletal dysplasia

How are genu varum and/or genu valgum diagnosed?

  • Physical exam

How are genu varum and/or genu valgum treated?

Genu varum and genu valgum usually resolve on their own. Normal growth and development over time may correct bowlegs and knock-knees.

In some instances, your child may need further evaluation and testing:

  • If the condition causes pain or discomfort
  • If the condition worsens after age 2
  • If the condition does not resolve itself by early adolescence

Your child’s doctor at Connecticut Children’s can assess if further testing is needed.

Doctors at Connecticut Children’s offer state-of-the-art limb lengthening and limb modification technologies, such as Ilizarov frames or the Precice nail. Additionally, Connecticut Children’s has a world-class motion analysis lab to diagnose complex walking abnormalities.

Osgood-Schlatter disease (OSD) is a common cause of knee pain in children and adolescents. It is an overuse injury that affects children while they are still growing.

OSD is the swelling and irritation of the growth plate at the top of the shinbone. It can affect one or both knees. OSD goes away when a child stops growing and usually does not cause lasting problems.

What are the signs and symptoms of Osgood-Schlatter disease?

  • Pain and swelling below the kneecap
  • Worsening pain with activity
  • Possible limping due to pain

What causes Osgood-Schlatter disease?

  • Growth spurts during puberty
  • Exacerbated by sports or activities involving a lot of running or jumping

How is Osgood-Schlatter disease diagnosed?

  • Physical exam
  • X-rays if necessary

How is Osgood-Schlatter disease treated?

Treatment depends on the extent of your child’s injury. Non-surgical options to treat Osgood-Schlatter disease include:

  • I.C.E. – Rest, ice, compression and elevation
  • Activity modification or restriction
  • Anti-inflammatory medication (e.g., ibuprofen)
  • Wrap or sleeve around the knee
  • Physical therapy

Surgery is only necessary in more severe or complicated cases of OSD. Doctors at Connecticut Children’s can determine the right plan to treat your child’s injury.

Sinding-Larsen-Johansson (SLJ) syndrome is a common cause of knee pain in teenagers. It is an overuse injury that affects children and teens during periods of rapid growth.

SLJ is the swelling and irritation of the growth plate at the bottom of the kneecap. This can lead to pain in the affected area. SLJ goes away when a teen stops growing and usually does not cause lasting problems.

What are the signs and symptoms of Sinding-Larsen-Johansson (SLJ) syndrome?

  • Swelling and tenderness around the kneecap
  • Worsening pain with activity
  • Worsening pain with kneeling or squatting
  • Swollen or bony bump at the bottom of the kneecap

What causes Sinding-Larsen-Johansson (SLJ) syndrome?

  • Growth spurts during puberty
  • Exacerbated by sports or activities involving a lot of running or jumping

How is Sinding-Larsen-Johansson (SLJ) syndrome diagnosed?

  • Physical exam
  • Imaging if necessary:
    • X-rays
    • Magnetic resonance imaging (MRI)

How is Sinding-Larsen-Johansson (SLJ) syndrome treated?

Treatment depends on the extent of your child’s injury. There are several non-surgical options to treat Sinding-Larsen-Johansson (SLJ) syndrome:

  • I.C.E. – Rest, ice, compression and elevation
  • Activity modification or restriction
  • Anti-inflammatory medication (e.g., ibuprofen)
  • Pain-relief medication (e.g., acetaminophen)
  • Physical therapy
  • Knee brace

Surgery is only necessary in more severe or complicated cases of SLJ. Doctors at Connecticut Children’s can determine the right plan to treat your child’s injury.

Click here to learn more about leg limb-length discrepancy and treatment options at Connecticut Children’s.

Foot & Ankle

The accessory navicular is an extra bone or piece of cartilage fused within the posterior tibial tendon. It is above the arch, located on the inner side of the foot. This bone is congenital—meaning it is present at birth. It is not part of the foot’s normal structure; most people do not have an accessory navicular.

People with this extra bone are often unaware of it unless it becomes painful. When the bone or tendon becomes aggravated, accessory navicular syndrome can develop.

What are the signs and symptoms of accessory navicular syndrome?

  • A visible bony bump located mid-foot on the inner side above the arch
  • Redness and swelling
  • Vague pain or throbbing in the midfoot and arch; pain usually occurs during or after an activity

What causes accessory navicular syndrome?

  • Trauma (e.g., a foot or ankle sprain)
  • Chronic irritation from shoes rubbing against the extra bone
  • Excessive activity or overuse

Many people with accessory navicular syndrome also have flat feet. Fallen arches put more strain on the posterior tibial tendon. This can lead to inflammation or irritation.

How is accessory navicular syndrome diagnosed?

  • Physical exam
  • X-rays

How is accessory navicular syndrome treated?

Treatment depends on the extent of your child’s condition. There are several non-surgical treatment options:

  • I.C.E. – Rest, ice, compression and elevation
  • Cast or boot
  • Anti-inflammatory medication (e.g., ibuprofen)
  • Physical therapy
  • Orthotic devices for arch support

Surgery is only necessary when non-surgical methods have failed to relieve symptoms. Doctors at Connecticut Children’s can help determine the right plan to treat your child’s condition.

Sprained ankles are a common injury in children. Sprains occur when there is a sudden movement or twist that moves the ankle from its normal position. When forced out of position, the ankle’s ligaments stretch or tear.

What are the signs and symptoms of a sprained ankle?

  • Pain and tenderness (mild, moderate or severe)
  • Swelling
  • Stiffness
  • Bruising
  • Limited range of motion
  • Inability to put weight on the ankle
  • Popping sound at the time of injury

What causes a sprained ankle?

A sprain occurs when a sudden movement forces the ankle out of position. Some ways this can happen include:

  • Foot or ankle rolling
  • Falls causing the ankle to twist
  • Landing awkwardly on the foot after jumping or pivoting
  • Walking or exercising on an uneven surface

How is a sprained ankle diagnosed?

  • Physical exam
  • Imaging if necessary:
    • X-rays
    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT) scan
    • Ultrasound

How is a sprained ankle treated?

Treatment depends on the extent of your child’s injury. Non-surgical options to treat an ankle sprain include:

  • I.C.E. – Rest, ice, compression and elevation
  • Activity modification or restriction
  • Anti-inflammatory medication (e.g., ibuprofen)
  • Pain-relief medication (e.g., acetaminophen)
  • Physical therapy
  • Brace or wrap
  • Crutches if needed

Surgery for an ankle sprain is rare and is only necessary to treat severe cases. Doctors at Connecticut Children’s can determine the right plan to treat your child’s sprained ankle.

Clubfoot is a common foot deformity that affects a child’s bones, muscles and tendons. It causes the heel to point down while the front of the foot turns inward. About 50% of children with clubfoot have bilateral clubfeet—meaning both feet.

If a child has a family history of clubfeet, they are more likely to be born with a clubfoot themselves. It is not a painful condition for babies. Most children who receive early treatment are able to run, play and function normally.

What are the signs and symptoms of a clubfoot?

With all cases of clubfoot, heels will point downward while the front of the foot points inward.

There are additional signs of clubfoot if only one foot is affected:

  • Calf muscle is smaller on affected leg
  • Short and wide foot on affected side
  • Leg on the affected side may be shorter than the other side

What causes clubfoot?

In most cases, the exact cause of clubfoot is unknown. A genetic component is likely.

Doctors can determine the cause of clubfoot in some cases. Causes include birth defects, medical conditions or awkward foot position in utero.

How is a clubfoot diagnosed?

Clubfoot is often diagnosed at birth based on the shape and positioning of an infant’s foot. Sometimes ultrasounds lead to a diagnosis of clubfoot before birth.

X-rays are rare and usually not needed.

How is a clubfoot treated?

Treatment depends on the extent of your child’s condition. Non-surgical options to treat clubfeet include:

  • The Ponseti method (which includes stretching and casting)
  • Taping or splinting the affected area
  • Braces
  • Physical therapy

Surgery for a clubfoot is only necessary when other treatments are ineffective. The type of surgery depends on the extent of their condition.

All physicians at Connecticut Children’s are certified and trained in the Ponseti method of care. Additionally, Connecticut Children’s offers a world-class motion analysis lab to diagnose complex walking abnormalities. Doctors at Connecticut Children’s can determine the right plan to treat your child’s clubfoot.

Curly toes are a common condition that affects infants and young children. It is present from birth and may become more noticeable as a child begins to walk.

This condition tends to occur in the third and fourth toes on both feet. The toes curl under because the tendons that bend the toes are too tight, pulling one toe under the next.

What are the signs and symptoms of curly toes?

Most children do not experience any symptoms from curly toes. The condition is only known because it is visible.

While usually asymptomatic, some children may experience:

  • Pain or discomfort with activity
  • Crossed toes
  • Sores, blisters or calluses
  • Occasional nail deformity

What causes curly toes?

This condition is hereditary. Curly toes tend to run in families; a child is more likely to have this condition if one or both parents does too.

How are curly toes diagnosed?

Doctors can diagnose curly toes based on appearance and examining the foot.

How are curly toes treated?

Treatment is usually not needed for curly toes unless a child experiences symptoms that cause pain or discomfort. However, your child may need surgery if curly toes cause persistent problems beyond 5-6 years old.

Doctors at Connecticut Children’s can determine the right plan to treat your child’s condition.

By definition, flat feet lack an arch and are flatter on the bottom. This allows the entire sole to touch the floor while standing. This condition is common, often running in families and usually painless.

Because their arches haven’t developed yet, flat feet are common in babies and toddlers. The foot arch develops through childhood for most individuals. (Though some people may never develop arches in their feet.)

What are the signs and symptoms of flat feet?

Most children with flat feet have no complaints or symptoms. Some children with flat feet may experience:

  • Foot pain in the heel or arch area
  • Increased foot pain with activity
  • Ankle swelling
  • Tight heel cords

It is important to talk to your child’s doctor if they have foot pain.

What causes flat feet?

There are various causes of flat feet.

In some cases, children are born with a predisposition for flat feet. Some inherit the flat feet from their family or develop it from a genetic condition. Children with joint hyper-mobility are more likely to have flat feet.

Others may develop flat feet over time. Risk factors for developing flat feet include:

  • Obesity
  • Certain health conditions (e.g., diabetes or arthritis)
  • Foot or ankle injuries

How are flat feet diagnosed?

  • Physical exam
  • Imaging if necessary:
    • X-rays
    • EOS imaging
    • Computed tomography (CT) scan
    • Magnetic resonance imaging (MRI)

How are flat feet treated?

In most cases, treatment is not needed following a diagnosis.

If your child experiences pain with their flat feet, non-surgical treatment options may be recommended. Treatments include:

  • Arch supports
  • Supportive shoes
  • Stretching exercises
  • Physical therapy
  • Rest
  • Pain-relief medication (e.g., acetaminophen)

Surgery is only recommended in severe cases if a child has a related foot or leg problem, such as a torn tendon or bone fusion. Doctors at Connecticut Children’s can determine the right plan to treat your child’s flat feet.

Some children may experience in-toeing or out-toeing. In-toeing is when feet turn inward while walking. This condition is sometimes called “pigeon-toe.” Almost all toddlers who in-toe go on to run, jump and play the same as other kids.

Out-toeing is when a child’s feet turn outwards when they walk—a condition also known as “duck feet.” This condition is less common than in-toeing.

What are the signs and symptoms of in-toe or out-toe?

There are different symptoms depending on whether a child in-toes or out-toes:

IN-TOE

  • Walking or running with feet pointed inward
  • Awkward walking or running possible
  • May cause tripping or falling

OUT-TOE

  • Walking or running with feet pointed outward
  • Awkward walking or running possible
  • Possible limp
  • Possible pain in the hip, thigh, knee, or foot

What causes in-toeing or out-toeing?

There are several possible causes of in-toeing and out-toeing:

IN-TOE

  • Slight twist in shin bones causing feet to turn in
  • Slight twist in thigh bones causing feet to turn in
  • Curved feet causing toes to point in

OUT-TOE

  • External rotation of the hip
  • Shin bones twisting outward
  • Family history of out-toe
  • Flat feet

 

Less common causes of out-toeing include thigh bones twisting outward, a diagnosis of Legg-Calvé-Perthes or a diagnosis of cerebral palsy.

How is in-toe or out-toe diagnosed?

  • Physical exam
  • X-rays if necessary

It is important to make an appointment with your child’s doctor to rule out an underlying cause for your child’s in-toe or out-toe.

How are in-toe and out-toe treated?

Treatment depends on the cause and the extent of your child’s condition. For many children, in-toe and out-toe resolve on their own without treatment. Surgery is only needed in cases where your child’s condition leads to pain or problems with walking and running.

Doctors at Connecticut Children’s can determine the right plan to treat your child’s in-toe or out-toe.

Toe walking is a common gait abnormality, especially in children learning to walk. It is a pattern of walking where a child walks on the balls of their feet and their heels do not touch the ground.

Many children outgrow toe walking, while some continue to do so out of habit. In very rare cases, continuing to toe walk past age 2 could be a sign of an underlying medical condition. Some children begin toe walking later in life. This is often caused by pain in the muscles or Achilles tendon.

What are the signs and symptoms of toe walking?

Toe walking is walking on the toes and balls of the feet. The exact cause of toe walking is unknown. In a small number of cases, toe walking can be a sign of underlying medical conditions.

What causes toe walking?

  • Inherited trait
  • Tight muscles
  • Short Achilles tendon
  • Neurological disorders
  • Neurodivergence (i.e., autism or ADHD)

How is toe walking diagnosed?

Toe walking is noted when a child walks on their toes and balls of their feet. Doctors may examine your child to check for underlying conditions or injuries. This may include a physical exam and a neurological exam.

How is toe walking treated?

In most cases, treatment is not needed after a diagnosis.

However, treatment may be necessary if an underlying condition causes your child’s toe walking. Non-surgical treatment options include:

  • Serial casting
  • Bracing
  • Botox therapy

Surgery is only necessary in more severe cases where walking flat-footed is not possible. Doctors at Connecticut Children’s can determine the right plan to treat your child’s toe walking.

Metatarsus adductus is a common foot deformity that causes the front half of the foot to turn inward. It may be classified as flexible or non-flexible.

This condition is often visible at birth. Babies with metatarsus adductus are at an increased risk for developmental hip dysplasia. It may also cause differences in leg length and lead a child to walk with a limp.

What are the signs and symptoms of metatarsus adductus?

  • Front part of the foot points inward
  • Foot may have a curved shape
  • Foot may point slightly under

What causes metatarsus adductus?

The exact cause of metatarsus adductus is unknown. One theory suggests the position of the fetus may contribute to this condition.

How is metatarsus adductus diagnosed?

  • Physical exam
  • X-rays if necessary

How is metatarsus adductus treated?

In most cases, metatarsus adductus resolves on its own and treatment is not needed. Stretching exercises may be recommended in some cases.

Surgery is rarely necessary. It is only recommended for children age 4 or older with a severe deformity. Doctors at Connecticut Children’s can determine the right treatment for your child’s condition.

Sever’s disease—or calcaneal apophysitis—is one of the most common causes of heel pain in children and teens. It is the inflammation of the growth plate in the heel of the foot.

What are the signs and symptoms of Sever’s disease?

  • Heel pain and tenderness
  • Mild swelling at the heel
  • Pain worsened with activity
  • Pain that is worse upon waking up
  • Limping or toe walking

What causes Sever’s disease?

  • Growth spurts during puberty
  • Exacerbated by sports or activities involving a lot of running or jumping
  • Pressure on the heel from standing too long (less common)

How is Sever’s disease diagnosed?

  • Physical exam

How is Sever’s disease treated?

Treatment depends on the extent of your child’s injury. Non-surgical options to treat Sever’s disease include:

  • I.C.E. – Rest, ice, compression and elevation
  • Activity modification or restriction
  • Anti-inflammatory medication (e.g., ibuprofen)
  • Supportive shoe inserts
  • Stretching exercises
  • Physical therapy

A short leg cast or walking boot may be used if symptoms are severe. Doctors at Connecticut Children’s can determine the right plan to treat your child’s injury.

Limb-Length Discrepancy

An arm-length discrepancy occurs when one arm is shorter than the other arm. The difference can range from a fraction of an inch to several inches.

Some children are born with limb differences that cause arms to grow at different rates. Other limb-length discrepancies may occur due to an injury or other conditions. Injuries and conditions include fractures, bone infections and bone cysts.

Arm-length discrepancies are less likely to affect a child’s daily activities than leg-length discrepancies.

There are two types of limb-length discrepancies. Structural discrepancies occur when a bone in one limb is shorter than the same bone in the other limb. Functional discrepancies occur when joint contracture throws off limb symmetry.

What are the signs and symptoms of an arm limb-length discrepancy?

The signs of an arm-length discrepancy vary. It depends on the cause and difference in length. Signs or symptoms may include:

  • One arm that is shorter than the other; this is not always noticeable or obvious
  • Difficulty reaching something with both hands (e.g., reaching both handlebars)
  • Difficulty sitting in or standing using the arms of a chair

What causes an arm limb-length discrepancy?

There are several causes of arm discrepancies. Some limb-length discrepancies are congenital (present at birth) and others are illness-related.

CONGENITAL

  • Child’s arm did not develop fully during pregnancy (no known cause)

ILLNESS-RELATED

  • Complex fracture that does not heal correctly
  • Damage to the growth plate due to injury or bone infection
  • Bone tumors or bone cysts
  • Cerebral palsy and other neuromuscular disorders

How is an arm limb-length discrepancy diagnosed?

  • Physical exam
  • X-rays
  • Additional testing if necessary
    • Genetic testing
    • Testing of other parts of the body if a medical condition is suspected

How is an arm limb-length discrepancy treated?

Treatment for an arm limb-length discrepancy depends on the cause and extent of your child’s condition. There are several non-surgical and surgical treatments options to treat arm limb-length discrepancies:

NON-SURGICAL

  • Physical therapy
  • Occupational therapy
  • Assistive or adaptive devices
  • Prosthetics

SURGICAL

  • Surgery to slow down or stop growth of the longer limb
  • Gradual lengthening of the shorter limb
  • Shortening of the longer limb
  • Reconstruction to parts of the hand, wrist and/or arm to improve alignment

Connecticut Children’s is equipped with state-of-the-art limb lengthening and limb modification technologies. Doctors at Connecticut Children’s can determine the right treatment plan for your child’s condition.

A leg-length discrepancy occurs when one leg is shorter than the other leg. The difference can range from a fraction of an inch to several inches.

Some children are born with limb differences that cause legs to grow at different rates. Other limb-length discrepancies may occur due to an injury or other conditions. Injuries and conditions include fractures, bone infections and bone cysts.

Leg limb-length discrepancies are more likely to affect a child’s daily activities than arm-length discrepancies. It may change their posture or walking patterns. Leg limb-length discrepancies may also lead to other problems. These problems include scoliosis and problems with the hip, knee and/or ankle.

There are two types of limb-length discrepancies. Structural discrepancies occur when a bone in one limb is shorter than the same bone in the other limb. Functional discrepancies occur when joint contracture throws off limb symmetry.

What are the signs and symptoms of a leg limb-length discrepancy?

The signs of a leg-length discrepancy vary. It depends on the cause and difference in length. Signs and symptoms may include:

  • One leg that is shorter than the other; this is not always noticeable or obvious
  • Walking problems (e.g., limping or toe-walking)
  • Pain in the back, hip, knee or ankle
  • Problems with posture
  • Knee is chronically hyper-extended on the short side and flexed on the long side

What causes a leg limb discrepancy?

There are several causes of leg-length discrepancies. Some limb-length discrepancies are congenital (present at birth) and others are illness-related.

CONGENITAL

  • Child’s leg did not develop fully during pregnancy (no known cause)
  • Child is born with a problem that changes the alignment of their hips (e.g., coxa vara or developmental hip dislocation)

ILLNESS-RELATED

  • Complex fracture that does not heal correctly
  • Damage to the growth plate due to injury or bone infection
  • Bone tumors or bone cysts
  • Cerebral palsy and other neuromuscular disorders

How is a leg limb-length discrepancy diagnosed?

  • Physical exam
  • X-rays
  • Additional testing if necessary
    • Genetic testing
    • Testing of other parts of the body if a medical condition is suspected

How is a leg limb-length discrepancy treated?

Treatment for a leg limb-length discrepancy depends on the cause and extent of your child’s condition. There are several non-surgical and surgical treatments options to treat leg limb-length discrepancies:

NON-SURGICAL

  • Physical therapy
  • Occupational therapy
  • Assistive or adaptive devices
  • Shoe lifts

SURGICAL

  • Surgery to slow down or stop growth of the longer limb
  • Gradual lengthening of the shorter limb
  • Shortening of the longer limb

Connecticut Children’s is equipped with state-of-the-art limb lengthening and limb modification technologies. Doctors at Connecticut Children’s can determine the right treatment plan for your child’s condition.

Fractures

A buckle fracture is the most common childhood fracture. It is a partial break of the bone. This happens when one side of the bone bends and buckles without breaking the other side of the bone.

What are the signs and symptoms of a buckle fracture?

  • Pain
  • Swelling
  • Bruising
  • Tenderness
  • Difficulty moving
  • Difficulty bearing weight

What causes a buckle fracture?

Buckle fractures—like other broken bones—can happen as the result of a fall or accident. Serious impact can lead to a buckle fracture.

How are buckle fractures diagnosed?

  • Physical exam
  • X-rays

How are buckle fractures treated?

In most cases, buckle fractures heal with immobilization, rest and activity restriction. Your child’s doctor may choose a splint or cast to treat the injury. Arm slings are sometimes recommended. Buckle fractures usually heal in 2-4 weeks.

It is important to treat fractures as soon as possible. Doctors at Connecticut Children’s can help if you suspect your child has a buckle fracture.

A scaphoid fracture is a break in one of the small bones of the wrist. The most common cause of this injury is falling onto an outstretched hand.

There are two classifications for scaphoid fractures: Non-displaced and displaced. When the bones still line up correctly, it is a non-displaced fracture. If bone fragments move out of position, it is a displaced fracture.

What are the signs and symptoms of a scaphoid fracture?

  • Pain
  • Swelling
  • Tenderness
  • Increased pain with pinching or gripping

Please note that some scaphoid fractures may be mistaken for a wrist sprain if the pain is mild. It is important your child sees their doctor if you suspect a fracture or if pain persists.

What causes a scaphoid fracture?

  • Falling onto an outstretched hand
  • Sports accidents
  • Vehicle accidents

How are scaphoid fractures diagnosed?

  • Physical exam
  • X-rays
  • Additional imaging if necessary:
    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT) scan

How are scaphoid fractures treated?

Treatment depends on the extent of your child’s injury. There are several non-surgical and surgical options to treat scaphoid fractures:

NON-SURGICAL

  • Cast or splint
  • Activity modification or restriction
  • Bone stimulator

SURGICAL

  • Arthroscopic reduction
  • Internal fixation with metal implants
  • Bone grafts (with or without internal fixation)

Doctors at Connecticut Children’s can determine the right plan to treat your child’s injury.

Tillaux fractures are traumatic ankle injuries that most often affect older adolescents. They typically occur in children between 12 and 14 years old as they reach skeletal maturity.

Tillaux fractures account for 3-5% of all pediatric ankle fractures.

What are the signs and symptoms of a Tillaux fracture?

  • Pain
  • Swelling
  • Inability to bear weight

What causes Tillaux fractures?

Tillaux fractures usually occur through low-velocity trauma. Examples include skateboard accidents or sliding injuries from sports like baseball.

How are Tillaux fractures diagnosed?

  • Physical exam
  • X-rays
  • Additional imaging if necessary:
    • Computed tomography (CT) scan

How are Tillaux fractures treated?

Treatment depends on the extent of your child’s injury. Non-surgical treatment can be effective if the displacement is less than 2mm. This involves a closed reduction, followed by immobilization in a cast.

Surgery is often recommended for displacement greater than 2mm.

Doctors at Connecticut Children’s can help determine the right plan to treat your child’s Tillaux fracture.

Spine

Idiopathic scoliosis is a type of scoliosis. Scoliosis is a condition where the spine twists and/or curves to the side. “Idiopathic” means there is no definite cause.

There are three types of idiopathic scoliosis:

INFANTILE

Diagnosed between birth and 3 years. Infantile scoliosis accounts for fewer than 1% of all pediatric cases. This is a type of early-onset scoliosis. Early-onset scoliosis is diagnosed prior to age 9 and includes infantile and juvenile scoliosis.

JUVENILE

Diagnosed between 3 and 9 years old. Juvenile scoliosis accounts for 12-20% of all pediatric cases. This is a type of early-onset scoliosis. Early-onset scoliosis is diagnosed prior to age 9 and includes infantile and juvenile scoliosis.

ADOLESCENT

Diagnosed between 10 and 18 years old. Adolescent scoliosis accounts for approximately 80% of all pediatric cases of idiopathic scoliosis.

Idiopathic scoliosis is the most common type of scoliosis. It is often mild with no treatment necessary.

Patient Stories

What are the signs and symptoms of idiopathic scoliosis?

  • Uneven shoulders
  • One shoulder blade that protrudes more than the other
  • Ribs more prominent on one side
  • Uneven waistline
  • Difference in hip height

What causes idiopathic scoliosis?

The cause of idiopathic scoliosis is unknown.

How is idiopathic scoliosis diagnosed?

  • Physical exam
  • X-rays
  • Additional imaging if needed
    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT) scan

Idiopathic scoliosis is often discovered during pediatric checkups or school screenings. If a pediatrician or school nurse suspects a child has scoliosis, they may recommend an evaluation by a pediatric orthopedist or spine specialist for an official diagnosis.

How is idiopathic scoliosis treated?

Treatment for idiopathic scoliosis depends on the extent of your child’s condition. In most cases, idiopathic scoliosis is mild and requires no treatment aside from simple observation.

Moderate to severe scoliosis may require further treatment. In cases of moderate scoliosis, a child can be treated with a brace. This can correct the curve or prevent it from getting worse. Children with severe scoliosis may require surgery.

Connecticut Children’s is experienced in the diagnosis and treatment of this condition. Doctors at Connecticut Children’s continue to research idiopathic scoliosis and its treatments. We have published extensively on this topic.

Neuromuscular scoliosis (NMS) is a type of scoliosis. Scoliosis is a condition where the spine twists and/or curves to the side. NMS is caused by an underlying medical condition that affects a body’s neurological and/or muscular system(s).

Patient Stories

What are the signs and symptoms of neuromuscular scoliosis?

  • Uneven shoulders
  • One shoulder blade that protrudes more than the other
  • Ribs more prominent on one side
  • Uneven waistline
  • Difference in hip height

Children with NMS may also have other types of spinal curves. This could include kyphosis (hunchback) or lordosis (swayback). Larger curves may reduce space in the chest and cause breathing problems.

What causes neuromuscular scoliosis?

NMS is caused by an underlying medical condition that affects the body’s neurological system and/or muscular system. Conditions include:

  • Muscular dystrophy
  • Cerebral palsy
  • Spina bifida

How is neuromuscular scoliosis diagnosed?

  • Physical exam
  • X-rays
  • Additional imaging if needed
    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT) scan

How is neuromuscular scoliosis treated?

Treatment for neuromuscular scoliosis depends on the extent of your child’s condition, as well as the underlying condition that caused it.

A multidisciplinary approach is needed to treat neuromuscular scoliosis. NMS treatment teams may include orthopedists, pediatricians, pulmonologists, neurologists and others. Because NMS results from other conditions, the underlying condition guides the treatment plan.

There are several non-surgical and surgical treatment options to treat neuromuscular scoliosis:

NON-SURGICAL

  • Physical therapy
  • Wheelchair modification
  • Bracing for patients who use a wheelchair (not recommended for NMS patients who walk; it may cause an unsteady gait)

SURGICAL

  • Spinal fusion for spine stabilization
  • MAGEC™ growing rods

MAGEC (MAgnetic Expansion Control) rods are surgically implanted but do not require repeated surgery to match a child’s growth; instead, they are lengthened non-invasively using powerful magnets outside the body

Connecticut Children’s is experienced in the diagnosis and treatment of this neuromuscular scoliosis, with expertise using MAGEC growing rods. Doctors at Connecticut Children’s continue to research neuromuscular scoliosis and its treatments. We have published extensively on this topic.

Scoliosis is a condition where the spine twists and/or curves to the side.

Early-onset scoliosis refers to the age of a child when diagnosed. Children diagnosed with scoliosis by age 10 have early-onset scoliosis. EOS could be idiopathic or neuromuscular.

Patient Stories

What are the signs and symptoms of early-onset scoliosis?

  • Uneven shoulders
  • One shoulder blade that protrudes more than the other
  • Ribs more prominent on one side
  • Uneven waistline
  • Difference in hip height

What causes early-onset scoliosis?

The cause of early-onset idiopathic scoliosis is unknown.

If a child has early-onset neuromuscular scoliosis, their condition is caused by an underlying condition. Conditions that may cause NMS include muscular dystrophy, cerebral palsy and spina bifida.

How is early-onset scoliosis diagnosed?

  • Physical exam
  • X-rays
  • Additional imaging if needed
    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT) scan

How is early-onset scoliosis treated?

Treatment for early-onset scoliosis depends on the extent of your child’s condition.

Mild cases of scoliosis require no treatment aside from simple observation. Moderate to severe scoliosis may require further treatment. In cases of moderate scoliosis, a child can be treated with a brace. This can correct the curve or prevent it from getting worse. Children with severe scoliosis may require surgery.

Connecticut Children’s is experienced in the diagnosis and treatment of this neuromuscular scoliosis, with expertise using MAGEC growing rods that grow with the child. Doctors at Connecticut Children’s continue to research neuromuscular scoliosis and its treatments.

Many people experience back pain at some point in their lives. While we often associate back pain with adults, children can experience back pain too.

Back pain can result from injury, strain or overuse. It may also result from other injuries or underlying medical conditions.

What are the signs and symptoms of back pain in children?

Back pain itself is a sign or symptom of a cause or condition. It can occur at any location across the spine. Sometimes it is accompanied by other symptoms that could indicate other medical conditions or injuries.

If a child is experiencing worsening pain or any of the symptoms below, it is important to check in with their doctor:

  • Fever
  • Weight loss
  • Pain at night or at rest
  • Trouble walking
  • Weakness
  • Numbness in the leg or foot
  • Pain that goes down one or both legs

What causes back pain in children?

Back pain is most often caused by injury, strain or overuse. Core imbalance or weakness can contribute to this pain.

Less common causes of back pain include infections, tumors, trauma or certain underlying medical conditions. Medical conditions that could result in back pain include scoliosis, kyphosis (hunchback) and spondylolysis (defects or broken area of bone).

How is back pain in children diagnosed?

Back pain is a symptom rather than a condition to be diagnosed. To understand the cause of back pain, a child’s doctor will look to diagnose any underlying condition or injury:

  • Physical exam
  • Additional imaging if necessary
  • Additional testing if necessary

How is back pain in children treated?

Treatment depends on the cause of your child’s back pain. Doctors at Connecticut Children’s can help diagnose the underlying cause and best possible treatment plan.

Motion/Movement

Your gait is the way you walk. If a person walks in an unusual way, it is known as a gait abnormality.

There are a number of reasons why a child may have a gait abnormality (e.g., injuries, underlying conditions or genetic factors). While walking may seem uncomplicated, it is a process that involves many systems of the body—including strength, coordination and neurological systems.

What are the signs and symptoms of a gait abnormality?

A gait abnormality itself is a sign or symptom of a cause or condition.

What causes gait abnormalities?

  • Illness or underlying medical condition
  • Genetic factors
  • Injuries
  • Abnormalities in the feet or legs

How is a gait abnormality diagnosed?

  • Physical exam
  • Additional imaging or testing to check for underlying conditions and nerve damage

How is a gait abnormality treated?

Treatment depends on the cause of your child’s abnormal gait. If a gait abnormality is caused by an underlying condition, it should correct itself once the condition is treated. Other conditions or injuries may require surgery or physical therapy. Long-term cases of a gait abnormality may require your child to use assistive devices, such as leg braces, crutches or a cane.

The Center for Motion Analysis at Connecticut Children’s can help diagnose and treat complex cases of walking abnormalities.

Click here to learn more about the Center for Motion Analysis at Connecticut Children’s.

Specializations

Connecticut Children’s Division of Orthopedics Hip Program offers comprehensive treatment for a full range of pediatric hip disorders. We are one of the only healthcare systems in the state of Connecticut to perform several hip repair and preservation surgeries.

Surgeries and treatments at Connecticut Children’s are used to address a number of pediatric hip disorders, including:

While the number of hip disorders in children can be overwhelming, the fellowship-trained pediatric surgeons at Connecticut Children’s have more than 25 years of combined experience in treating these conditions. We specialize in both surgical and non-surgical treatment options—with a goal of achieving the best possible outcome for your child.

Hip Preservation, Surgery & Osteotomies

Our mission at Connecticut Children’s is to keep kids moving. We are the only healthcare system in the state of Connecticut to perform surgical hip dislocation surgery and one of the only systems in the state to perform hip preservation surgeries.

The Hip Program at Connecticut Children’s is the only program in the state to perform complex pelvic osteotomies—including Ganz or periacetabular osteotomy (PAO) surgeries—to treat teenage and young adult patients with hip dysplasia. Our program is also one of just a few in the nation to offer a complex approach to surgical hip dislocation to treat disorders such as slipped capital femoral epiphysis (SCFE).

Additionally, our providers at Connecticut Children’s specialize in minimally invasive hip arthroscopy. This is an advanced approach to treating joint problems without needing to create a large incision.

Meet Our Hip Surgeons

Mark C. Lee, MD

860.837.7400

Connecticut Children’s Specialty Group

Specialties:

REQUEST AN APPOINTMENT

 

Allison Elizabeth Crepeau, MD

Orthopedic Surgeon

860.837.7400

Connecticut Children’s Specialty Group

Specialties:

REQUEST AN APPOINTMENT

Connecticut Children’s is a world leader in evaluation, diagnosis and treatment for abnormal walking patterns in children. Specialists at our state-of-the-art Center for Motion Analysis evaluate a full spectrum of diseases and conditions that may cause gait abnormalities. Conditions include:

What makes the Center for Motion Analysis at Connecticut Children’s different?

The Center for Motion Analysis uses leading-edge technology to identify muscle activity, movement and other mobility nuances unique to each child. This information allows specialists to develop highly-detailed, individualized treatment plans. It also helps accurately measure your child’s progress.

One of the first labs of its kind, the Center for Motion Analysis is the only fully accredited motion analysis laboratory in the Northeast. A thriving research hub, the Center for Motion Analysis pushes boundaries to understand pathologic movement disorders.

Connecticut Children’s is one of three centers in the world offering a rotating annual conference on the techniques and nuances of motion analysis.

Doctors at Connecticut Children’s are experienced in treating conditions of the spine, including scoliosis. Connecticut Children’s offers diagnosis and treatment for three types of scoliosis:

Idiopathic Scoliosis

Doctors at Connecticut Children’s continue to research idiopathic scoliosis and its treatments. They have published extensively on this topic.

Click here to learn more about diagnosis and treatment of idiopathic scoliosis at Connecticut Children’s.

Neuromuscular Scoliosis

Doctors at Connecticut Children’s continue to research neuromuscular scoliosis and its treatments. They have published extensively on this topic.

Click here to learn more about diagnosis and treatment of neuromuscular scoliosis at Connecticut Children’s.

Early-Onset Scoliosis

Doctors at Connecticut Children’s are experienced in offering unique treatments for early-onset scoliosis—including magnetically-controlled rods that grow with the child.

Click here to learn more about diagnosis and treatment of early-onset scoliosis at Connecticut Children’s.

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