Introduction: Growing pains are a common complaint in school age children, but no definite organic causes have been identified. An association between musculoskeletal pain and joint laxity has been proposed. This study therefore investigates the relationship between growing pains and joint hypermobility in children.

Materials and Methods: Thirty three children with growing pains and thirty one controls of similar age and sex were recruited from outpatient clinics of a specialist paediatric hospital. Joint hypermobility was assessed in each group using the Beighton score. A Beighton score of greater than or equal to 4 out of 9 was considered hypermobile.

Results: The median Beighton scores were 6 for the study group and 0 for the control group. 93.3% of the study group had a Beighton score of equal to or greater than 4, compared to 22.6% of the control group. There was a highly significant difference in Beighton score between the two groups (P< 0.0001), with an estimated difference of 4 points 95% CI 4–6.

Discussion and Conclusion: A link between joint hyper-mobility and musculoskeletal symptoms has been demonstrated in adults. There is also some evidence that hypermobile children are more likely to experience musculoskeletal pain, particularly articular, but the extent to which joint hypermobility is related to growing pains specifically has been poorly defined. We have investigated a selective population of children with growing pains and have shown them to be significantly more hypermobile than the control children. The aetiology of growing pains remains unclear. While the growing pains will get better, in view of the possible association of joint hypermobility and other musculoskeletal complains, these children should be carefully assessed for joint laxity.

The purpose of this study was to evaluate the effect on movement under load of different techniques of reattachment of the humeral tuberosities following 4-part proximal humeral fracture.

Biomechanical test sawbones were used. 4-part fracture was simulated and a cemented Neer3 prosthesis inserted. Three different techniques of reattachment of the tuberosities were used – 1)tuberosities attached to the shaft, and to each other through the lateral fins in the prosthesis with one cerclage suture through the anterior hole in the prosthesis, 2)as 1 without cerclage suture, and 3)tuberosities attached to the prosthesis and to the shaft. All methods used a number 5 ethibond suture. Both tuberosities and the shaft had multiple markers attached. Two Digital cameras formed an orthogonal photogrammetric system allowing all segments to be tracked in a 3-D axis system. Humeri were incrementally loaded in abduction using an Instron machine, to a minimum 1200N, and sequential photographs taken. Photographic data was analysed to give 3-D linear and angular motions of all segments with respect to the anatomically relevant humeral axis, allowing intertuberosity and tuberosity-shaft displacement to be measured.

Techniques 1 and 2 were the most stable constructs with technique 3 allowing greater separation of fragments and angular movement. True intertuberosity separation at the midpoint of the tuberosities was significantly greater using technique 3 (p< 0.05). The cerclage suture used in technique 2 added no further stability to the fixation.

In conclusion, our model suggests that the most effective and simplest technique of reattachment involves suturing the tuberosities to each other as well as to the shaft of the humerus. The cerclage suture appears to add little to the fixation in abduction, although the literature would suggest it may have a role in resisting rotatory movements.