title: The incidence of idiopathic musculoskeletal pain in children with upper extremity injuries.
abstract: BACKGROUND
  Children with upper extremity injuries may report persistent pain beyond the period of acute injury. In the published literature, it is unclear whether these children develop idiopathic musculoskeletal pain (IMP) such as complex regional pain syndrome (CRPS). The purpose of this study was to determine the incidence rate of IMP after upper extremity injury in school-aged children over a 5-year period and to describe the characteristics of these children.
  
  
  METHODS
  A retrospective case series was conducted of all children aged 8-18 years with an upper extremity injury who attended the outpatient hand clinic in a tertiary care pediatric hospital.
  
  
  RESULTS
  A reported incidence rate of IMP was 1.9% over a 5-year period in the 879 children reviewed. Girls were more likely to have IMP. The categorical distribution of the type, etiology and anatomical location of injury was proportionately different for those with IMP compared to those without documentation of IMP. In comparison, a higher percentage of children with IMP reported disproportionate pain and hypersensitivity or neuropathic pain symptoms compared to the children who had pain from a known etiology.
  
  
  CONCLUSIONS
  The incidence rate of IMP after upper extremity injury in school-aged children is low. Some common characteristics of this population that may help clinicians identify these children and make timely referrals for treatment include female gender, disproportionate pain, previously seen by multiple specialists, generalized injury in the hand, unspecific etiology or type of injury and unremarkable x-rays.
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Ontario, Canada; Faculty of Health Sciences, University of Ottawa, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Canada. Electronic address: Emily.ho@sickkids.ca.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Ho
authors.affiliation: Faculty of Health Sciences, University of Ottawa, Canada.
authors.forename: Johanna
authors.initials: J
authors.lastname: Ponnuthurai
authors.affiliation: Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Ontario, Canada; Department of Surgery, University of Toronto, Canada.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Clarke
mesh_terms: D000293:Adolescent; D002648:Child; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D008297:Male; D010146:Pain / Q000453:epidemiology* / Q000209:etiology; D016059:Range of Motion, Articular; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D034941:Upper Extremity / Q000293:injuries*
keywords: Female; Hand injury; Pain; School-aged children