Download PDF
Klin Padiatr 2017; 229(05): 293-301
DOI: 10.1055/s-0043-111596
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

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

Arthrosonografische Normwerte für das Schultergelenk gesunder Kinder und Jugendlicher: Ergebnisse einer multizentrischen Studie
Ralf Trauzeddel
1   Department of Pediatric Rheumatology, Helios Hospital Berlin-Buch, Berlin, Germany
,
Daniel Windschall
2   Department of Pediatrics, Asklepios Hospital Weißenfels, Weißenfels, Germany
,
Ralf Felix Trauzeddel
3   Department of Anesthesiology and Intensive Care Medicine, Campus Mitte and Virchow Klinkum Charite, University Medicine Berlin, Berlin, Germany
,
Christine Nirschl
2   Department of Pediatrics, Asklepios Hospital Weißenfels, Weißenfels, Germany
,
Gerd Ganser
4   Department of Pediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst, Germany
,
Katharina Palm-Beden
4   Department of Pediatric and Adolescent Rheumatology, St. Josef-Stift Sendenhorst, Sendenhorst, Germany
,
Rainer Berendes
5   Department of Pediatric Rheumatology, St. Marien’s Children’s Hospital, Landshut, Germany
,
Maria Haller
6   Practice for Pediatrics and Pediatric Rheumatology Gundelfingen, Germany
,
Manuela Krumrey-Langkammerer
7   German Center of Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
,
Antje Nimtz-Talaska
8   Practice for Pediatrics and Pediatric Rheumatology Frankfurt/Oder, Germany
,
Philipp Schoof
9   Practice for Pediatrics and Pediatric Rheumatology, Munich, Germany
,
Hartwig Lehmann
10   Department of Pediatrics, Justus Liebig University Giessen, Giessen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
24 August 2017 (online)

Also available at
    Permissions and Reprints

Abstract

Background Defining of gray scale ultrasound standard reference values of the shoulder joint in childhood and adolescence during maturation. Patients: We examined 445 healthy girls and boys between 1 year and 18 years of age.

Method 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.

Results 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.

Discussion 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.

Conclusion The findings could be helpful to differentiate between physiological and pathological joint conditions and thereby distinguishing age-related variations from alterations caused by inflammation.

Zusammenfassung

Hintergrund Bestimmung arthrosonografischer alters- und geschlechtsspezifischer Normwerte für das Schultergelenk im Kindes- und Jugendalter mittels B-Bild-Verfahren. Patienten: Mittels hochauflösendem B-Bildverfahren erfolgte die Untersuchung von 445 gesunden Jungen und Mädchen zwischen dem 1. und 18. Lebensjahr.

Methode In einer multizentrischen Studie erfolgte die beidseitige Untersuchung des Schultergelenks. Die Daten wurden geschlechts- und altersabhängig ausgewertet, wobei 6 Altersgruppen, die jeweils 3 Jahre umfassten, gebildet wurden um altersabhängige Gelenkveränderungen zu erfassen. Bestimmt wurden die Distanz zwischen Gelenkkapsel und Knochenoberfläche zur Beschreibung der Größe des Gelenkbinnenraums sowie die Dicke von Gelenkkapsel und Gelenkknorpel. Die Ergebnisse wurden als Mittelwert und Referenzintervall angegeben. Gelenkkapselform und Kapsel-Knochen-Übergang wurden qualitativ beschrieben.

Ergebnisse Die Gelenkknorpeldicke vermindert sich mit zunehmender Skelettreife unabhängig von Geschlecht und Körperseite. Der Abstand zwischen Gelenkkapsel und Knochenoberfläche sowie die Kapseldicke nehmen mit dem Alter zu. Die Gelenkkapsel ist vorwiegend konkav, der Übergang der Gelenkkapsel auf den Knochen spitzwinklig.

Diskussion Erstmals erfolgte die Erhebung von alters- und geschlechtsabhängigen Normwerten für den Gelenkbinnenraum sowie für die Gelenkkapsel- und Knorpeldicke gesunder Kinder.

Schlussfolgerung Die Kenntnis der beschriebenen altersabhängigen Wachstumsveränderungen kann zur sicheren sonografischen Abgrenzung physiologischer Gelenkprozesse von pathologischen Gelenkpr0ozessen beitragen.

Key words

joint maturation - standard reference values - arthrosonography - shoulder joint anatomy - childhood and adolescence - Juvenile idiopathic arthritis

Schlüsselwörter

Gelenkentwicklung - Standardwerte - Gelenkultraschall - Schultergelenk - Kindheit und Adoleszenz - Juvenile idiopathische Arthritis
 

  • References

  • 1 Backhaus M, Burmester GR. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001; 60: 641-649
    CrossrefPubMedGoogle Scholar
  • 2 Collado P, Naredo E, Calvo C. et al. Assesment of the joint recesses and tendon sheats in healthy children by high resolution B-mode and powerDoppler sonography.pdf. Clin Exp Rheumatol 2007; 25: 915-921
    PubMedGoogle Scholar
  • 3 Grechenig W, Mayr J. Peicha et al. Sonoanatomie des Schulter. Radiologe 2001; 41: 786-792
    CrossrefPubMedGoogle Scholar
  • 4 Haslam KE, McCann LJ, Wyatt S. et al. The detection of subclinical synovitis by ultrasound in oligoarticular juvenile idiopathic arthritis: a pilot study. Rheumatology (Oxford) 2010; 49: 123-127
    CrossrefPubMedGoogle Scholar
  • 5 Institute C and LS. Definig, Establishing and Verifying Reference Intervals in the Clinical Laboratory; Approved Guideline. Third Edit Wayne, PA: Clinical and Laboratory Standards Institute; 2008
    Google Scholar
  • 6 Karmazyn B, Bowyer SL, Schmidt KM. et al. US findings of metacarpophalangeal joints in children with idiopathic juvenile arthritis. Pediatr Radiol 2007; 37: 475-482
    CrossrefPubMedGoogle Scholar
  • 7 Keshava SN, Gibikote SV, Mohanta A. et al. Ultrasound and magnetic resonance imaging of healthy paediatric ankles and knees: a baseline for comparison with haemophilic joints. Haemophilia 2015; 21: 1-13
    PubMedGoogle Scholar
  • 8 Koski JM. Axillar ultrasound of the glenohumeral joint. J Rheumatol 1989; 16: 664-667
    PubMedGoogle Scholar
  • 9 Magni-Manzoni S, Collado P, Jousse-Joulin S. et al. Current state of musculoskeletal ultrasound in paediatric rheumatology: results of an international survey. Rheumatology (Oxford) 2014; 53: 491-496
    CrossrefPubMedGoogle Scholar
  • 10 Magni-Manzoni S, Epis O, Ravelli A. et al. Comparison of clinical versus ultrasound-determined synovitis in juvenile idiopathic arthritis. Arthritis Rheum 2009; 61: 1497-1504
    CrossrefPubMedGoogle Scholar
  • 11 Mellerowicz H, Hauer RW, Schmidt WA. et al. Technique and diagnostic value of musculoskeletal ultrasonography in rheumatology. Part 5: Ultrasonography of the shoulder. Z Rheumatol 2002; 61: 577-589
    CrossrefPubMedGoogle Scholar
  • 12 Naredo E, D’Agostino MA, Conaghan PG. et al. Current state of musculoskeletal ultrasound training and implementation in Europe: results of a survey of experts and scientific societies. Rheumatology (Oxford) 2010; 49: 2438-2443
    CrossrefPubMedGoogle Scholar
  • 13 Pradsgaard DO, Spannow AH, Heuck C. et al. Decreased Cartilage Thickness in Juvenile Idiopathic Arthritis Assessed by Ultrasonography. J Rheumatol 2013; 40: 1596-1603
    CrossrefPubMedGoogle Scholar
  • 14 Ramos PC, Ceccarelli F, Jousse-Joulin S. Role of ultrasound in the assessment of juvenile idiopathic arthritis. Rheumatology (Oxford) 2012; 51 (Suppl. 07) VII 10-12
    PubMedGoogle Scholar
  • 15 Reed AH, Henry RJ, Mason WB. Influence of statistical method used on the resulting estimate of normal range. Clin Chem 1971; 17: 275-284
    PubMedGoogle Scholar
  • 16 Roth J, Jousse-Joulin S, Magni-Manzoni S. et al. Definitions for the sonographic features of joints in healthy children. Arthritis Care Res (Hoboken) 2015; 67: 136-142
    CrossrefPubMedGoogle Scholar
  • 17 Schmidt WA, Schmidt H, Schicke B. et al. Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis 2004; 63: 988-994
    CrossrefPubMedGoogle Scholar
  • 18 Spannow AH, Pfeiffer-Jensen M, Andersen NT. et al. Ultrasonographic measurements of joint cartilage thickness in healthy children: Age- and sex-related standard reference values. J Rheumatol 2010; 37: 2595-2601
    CrossrefPubMedGoogle Scholar
  • 19 Spannow AH, Stenboeg E, Pfeiffer-Jensen M. et al. Ultrasound and MRI measurements of joint cartilage in healthy children: A validation study. Ultraschall in Med 2011; 32: 110-116
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Thomas C. Gelenke. In: Thomas C. editor. Spez. Pathol. Stuttgart NewYork: Schattauer Verlag; 1996: 584-589
    Google Scholar
  • 21 Viehweger G. Oberarm. In: Diethelm L, Olsson O, Strnad F, Ieten H, Zuppinger A. editors. Encycl Med Radiol. Berlin, Heidelberg, New York: Springer-Verlag; 1968: 309-310
    Google Scholar
  • 22 Wunsch R, Dudwiesus H, Reinehr T. Prospektiver Vergleich verschiedener Ultraschallverfahren zur Dickenmessung im Grenzbereich von Dicken unter 1 Millimeter. Fortschr Roentgenstr 2007; 179: 65-71
    Article in Thieme ConnectPubMedGoogle Scholar