How to Distinguish Meyer Dysplasia From Growing Pains
Consultation & Comments
Reader Reaction and Timely Answers From Experts
I read with interest the What’s Your Diagnosis? feature, “Young Boy With Intermittent Leg Pain” (CONSULTANT FOR PEDIATRICIANS, June 2011, page 196). How would you tell the difference between a patient with growing pains and one with Meyer dysplasia, if both have normal physical examination and laboratory findings?
Dr Julie Hodge
Thank you. That is a very good question. The conditions are challenging to differentiate clinically. Meyer dysplasia is relatively uncommon and can be easily mistaken for Legg-Calvé-Perthes disease.1 In contrast, growing pains occur in about 37% children aged 4 to 6 years.2
In general, both conditions present in the same age group. However, Meyer dysplasia occurs and ends earlier (younger than 5 years), whereas growing pains begin between the ages of 3 and 5 years and are most prominent between the ages of 8 and 12 years.3,4 Growing pains are more common in girls, whereas Meyer dysplasia is more common in boys.
Pain, limping, and limitation of movement are rare in Meyer dysplasia, and when present are usually mild and transient. Meyer dysplasia affects mainly the hip. The condition is bilateral in about half of cases.
Growing pains are characteristically intermittent and can continue for several months or years, with symptom-free intervals of days or weeks.3,4 Affected children have normal mobility. The most
common sites of pain are the shins, calves, or popliteal fossae.3,4 The pain is deep and usually localized to the muscles. That growing pains are almost always bilateral helps differentiate them from focal, potentially pathologic processes, which are frequently unilateral.3,4 Growing pains range from mild aching to excruciating pain. In older children, they may take the form of leg cramps, creeping sensations, or restless legs. Growing pains occur most frequently in the evening. Parents often report that the pain occurs or is worse after a day of more intense physical activity. The pain, which can last from a few minutes to a few hours, may awaken the child from sleep but typically resolves completely by morning.3,4
The main difference between the 2 conditions is the radiographic findings of cortical irregularity and sclerosis (Figure), which are absent in children with growing pains. Because both conditions are benign, their management is similar. However, when there is high suspicion for other hip or joint pathology, it is important to obtain imaging.
Anand Dusad, MD
Veterans Administration Medical Center and College of Pharmacy
University of Nebraska Medical Center
Omaha
Alexander K. C. Leung, MD
Clinical Professor of Pediatrics
University of Calgary
Pediatric Consultant
Alberta Children’s Hospital