Arthrosonographic Reference Values of the Shoulder Joint in Healthy Children and Adolescents: A Cross-Sectional Multicentre Ultrasound Study

Abstract

We examined 445 healthy girls and boys between 1 year and 18 years of age. A cross-sectional multicentre grey-scale ultrasound study was performed to examine the shoulder joint on both sides. The children were divided according to their gender and were further classified into six age groups, which constituted three-year age ranges, to record anatomical development changes. We measured the capsule-bone distance (BCD) as a representation of the intracapsular cavity, as well as the thickness of the joint capsule and joint cartilage. Values were expressed in mean±standard deviation (SD) and minimum-maximum (min-max). The shape of the joint capsule and capsule-bone junction zone was qualitatively analysed. The joint cartilage thickness decreased with increasing age in all joints independently from sex and body side. However, the BCD and the capsule thickness increased with age. There was no intraarticular fluid visible. The joint capsule had a predominantly concave form, whereas the capsule-bone junction was mostly sharp. This study is the first describing age-related normal values of the intracapsular cavity, joint capsule and cartilage thickness as well as their respective shape in a large cohort of healthy children. The findings could be helpful to differentiate between physiological and pathological joint conditions and thereby distinguishing age-related variations from alterations caused by inflammation.

Normative ultrasound references for the paediatric wrist; dorsal soft tissues

“…Normal, child-specific US references have been published for the hip joint 5 6 and, more recently, for the shoulder. 7 However, data for other joints are sparse although the Paediatric Group of the Outcome Measures in Rheumatology (OMERACT) US Task Force addressed the issue in a few papers. 8 9 Further, despite the existence of multiple studies that used US to assess synovitis in JIA, 10 there are no well-accepted US protocol recommendations for assessing joints of children with JIA.…”

What’s new in musculoskeletal ultrasound in pediatric rheumatology?

“…Fluid within the suprapatellar recess of the knee (less than 3 mm in thickness) was commonly found in almost all age groups and better visualized during contraction of the quadriceps muscles [13,20]. None of the healthy children investigated showed joint hip or anterior elbow joint fluid [19][20][21].…”

“…US standards according to age in healthy children have been published so far for the hip joint [22,23] and recently, for the shoulder [21] and wrist [24],which can be beneficial for defining the pathologic changes in every day practice.…”

Ultraschalldiagnostik in der Kinderrheumatologie

“…Einige Arbeiten konnten die wichtige Bedeutung der Ultraschalltechnik für die Kinderrheumatologie, insbesondere für die Diagnosestellung der Juvenilen idiopathischen Arthritis (JIA), hervorheben [5,6,8]. Die Standardisierung und Evidenz für den routinemäßigen Einsatz der Ultraschalltechnik wächst zunehmend auf der Basis zahlreicher Studien, die in den vergangenen Jahren sonografische Normbefunde sowie international konsentierte Standards für die Erhebung, Interpretation und auch Schwereeinteilung bei der Gelenkentzündung publizieren konnten [14][15][16][17][18][19][20][21][22][23]. Bei der Gelenksonografie werden für eine gute Abbildung der Weichteile möglichst hohe Ultraschallfrequenzen eingesetzt.…”