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Musculoskeletal pain is a common chief complaint of children in the emergency department. Although nonspecific and typically benign, musculoskeletal pain should be investigated thoroughly with consideration for an underlying bone tumor, especially when it is a recurrent visit for pain. This issue reviews the specific signs, symptoms, and unique presentations the emergency clinician should know when evaluating a pediatric patient with musculoskeletal pain. Additionally, assessment of relevant radiographic findings to assist in differentiating bone tumors and guide further management are discussed.
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Following are the most informative references cited in this paper, as determined by the authors.
1. * Gereige R, Kumar M. Bone lesions: benign and malignant. Pediatr Rev. 2010;31(9):355-362. (Review article) DOI: 10.1542/pir.31-9-355
2. * Vartevan A MC, Barnes CE. Pediatric bone imaging: differentiating benign lesions from malignant. Appl Radiol. 2018;47(7):8-15. (Review article)
3. SEER Cancer Statistics Review, 1975-2018. Accessed: June 15, 2021. Bethesda: National Cancer Institute. (Statistical report)
6. * McCarville MB. The child with bone pain: malignancies and mimickers. Cancer Imaging. 2009;9 Spec No A:S115-S121. (Review article) DOI: 10.1102/1470-7330.2009.9043
21. * Aboulafia AJ, Kennon RE, Jelinek JS. Benign bone tumors of childhood. J Am Acad Orthop Surg. 1999;7(6):377-388. (Review article) DOI: 10.5435/00124635-199911000-00004
Atesok KI, Alman BA, Schemitsch EH, et al. Osteoid osteoma and osteoblastoma. J Am Acad Orthop Surg. 2011;19(11):678-689. (Review article)
24. * Motamedi K, Seeger LL. Benign bone tumors. Radiol Clin North Am. 2011;49(6):1115-1134. (Review article) DOI: 10.1016/j.rcl.2011.07.002
26. * Copley L, Dormans JP. Benign pediatric bone tumors. Evaluation and treatment. Pediatr Clin North Am. 1996;43(4):949-966. (Review article) DOI: 10.1016/s0031-3955(05)70444-2
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Keywords: bone tumor, primary bone tumor, pediatric bone tumor, pediatric bone cancer, malignant, benign, osteosarcoma, Ewing sarcoma, Langerhans cell histiocytosis, osteochondroma, cartilaginous cap, osteoid osteoma, osteoblastoma, chondroblastoma, enchondroma, chondromyxoid fibroma, unicameral bone cyst, aneurysmal bone cyst, nonossifying fibroma, fibrous dysplasia, osteofibrous dysplasia, musculoskeletal pain, Codman triangle, nocturnal pain, pathologic fracture
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Mahnoosh Nik-Ahd, MD, MPH, FAAP; Anurag K. Agrawal, MD; Melissa Zimel, MD, FAAOS
Jeffrey T. Neal, MD; Elysha Pifko, MD
July 2, 2021
August 1, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.
CME Objectives
CME Information
Date of Original Release: July 1, 2021. Date of most recent review: June 15, 2021. Termination date: July 1, 2024.
Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.
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ACEP Accreditation: Pediatric Emergency Medicine Practice is also approved by the American College of Emergency Physicians for 48 hours of ACEP Category I credit per annual subscription.
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AOA Accreditation: Pediatric Emergency Medicine Practice is eligible for up to 48 American Osteopathic Association Category 2-A or 2-B credit hours per year.
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Goals: Upon completion of this activity, you should be able to: (1) demonstrate medical decision-making based on the strongest clinical evidence; (2) cost-effectively diagnose and treat the most critical ED presentations; and (3) describe the most common medicolegal pitfalls for each topic covered.
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