Ultrasound of the joints and entheses in healthy children

Nancy A. Chauvin, Victor Ho-Fung, Diego Jaramillo, J. Christopher Edgar, Pamela F. Weiss

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Tendon insertion pathologies such as enthesitis and apophysitis in children can result from trauma, overuse syndrome and arthritis. Knowledge of the US appearance of normal joints by age might aid diagnosis of pathologies. Objective: We describe the age-related sonographic features of the elbows, knees and feet in healthy children, providing a reference for the normal appearance of tendon insertions, apophyseal cartilage and bursae. Materials and methods: This is a prospective cross-sectional study of 30 healthy children. Children were grouped according to age: group 1 (4–9 years, n = 11), group 2 (10–13 years, n = 9) and group 3 (14–18 years, n = 10). Children completed pain and function questionnaires and underwent a standardized joint examination by a pediatric rheumatologist. The common extensor, common flexor, quadriceps, patellar and Achilles tendons and plantar fascia insertions were evaluated with gray-scale and power Doppler ultrasound. The anterior elbow, suprapatellar and retrocalcaneal bursae were evaluated for fluid. We measured the apophyseal cartilage thickness at the enthesis. Correlation analyses examined associations between age and tendon thickness. We used ANOVA, with location as a repeated measure, to test for gender differences in cartilage thickness. Results: Children had a median age of 12.4 years and 55% were boys. All 360 entheses appeared normal on gray-scale imaging. There was a strong linear relationship between tendon thickness and age. Tendon vascularity was only present in young children (group 1), in 7/22 (32%) quadriceps tendons. Peri-tendinous power Doppler signal was seen at seven sites: two patellar, four quadriceps and one common flexor tendon, and all these children were in group 2. Suprapatellar bursal fluid <3 mm was detected in 9/60 (15%) knees. Of the children in group 1, boys had thicker apophyseal cartilage than girls at the medial epicondyle, patellar poles and os calcis (P < 0.05). Conclusion: Tendon vascularity may be a normal finding in young children, and mild peri-tendinous vascularity is not uncommon in children 10–13 years of age. Tendon thickness has a linear relationship with age; however cartilage thickness varies across sites and also differs as a function of gender

Original languageEnglish (US)
Pages (from-to)1344-1354
Number of pages11
JournalPediatric Radiology
Volume45
Issue number9
DOIs
StatePublished - Aug 7 2015

Fingerprint

Tendons
Joints
Cartilage
Elbow
Knee
Pathology
Cumulative Trauma Disorders
Doppler Ultrasonography
Patellar Ligament
Achilles Tendon
Fascia
Arthritis
Foot
Analysis of Variance
Age Groups
Cross-Sectional Studies
Pediatrics
Pain
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Radiology Nuclear Medicine and imaging

Cite this

Chauvin, N. A., Ho-Fung, V., Jaramillo, D., Edgar, J. C., & Weiss, P. F. (2015). Ultrasound of the joints and entheses in healthy children. Pediatric Radiology, 45(9), 1344-1354. https://doi.org/10.1007/s00247-015-3313-0
Chauvin, Nancy A. ; Ho-Fung, Victor ; Jaramillo, Diego ; Edgar, J. Christopher ; Weiss, Pamela F. / Ultrasound of the joints and entheses in healthy children. In: Pediatric Radiology. 2015 ; Vol. 45, No. 9. pp. 1344-1354.
@article{c27697da67ef4d268a45d9debebf0850,
title = "Ultrasound of the joints and entheses in healthy children",
abstract = "Background: Tendon insertion pathologies such as enthesitis and apophysitis in children can result from trauma, overuse syndrome and arthritis. Knowledge of the US appearance of normal joints by age might aid diagnosis of pathologies. Objective: We describe the age-related sonographic features of the elbows, knees and feet in healthy children, providing a reference for the normal appearance of tendon insertions, apophyseal cartilage and bursae. Materials and methods: This is a prospective cross-sectional study of 30 healthy children. Children were grouped according to age: group 1 (4–9 years, n = 11), group 2 (10–13 years, n = 9) and group 3 (14–18 years, n = 10). Children completed pain and function questionnaires and underwent a standardized joint examination by a pediatric rheumatologist. The common extensor, common flexor, quadriceps, patellar and Achilles tendons and plantar fascia insertions were evaluated with gray-scale and power Doppler ultrasound. The anterior elbow, suprapatellar and retrocalcaneal bursae were evaluated for fluid. We measured the apophyseal cartilage thickness at the enthesis. Correlation analyses examined associations between age and tendon thickness. We used ANOVA, with location as a repeated measure, to test for gender differences in cartilage thickness. Results: Children had a median age of 12.4 years and 55{\%} were boys. All 360 entheses appeared normal on gray-scale imaging. There was a strong linear relationship between tendon thickness and age. Tendon vascularity was only present in young children (group 1), in 7/22 (32{\%}) quadriceps tendons. Peri-tendinous power Doppler signal was seen at seven sites: two patellar, four quadriceps and one common flexor tendon, and all these children were in group 2. Suprapatellar bursal fluid <3 mm was detected in 9/60 (15{\%}) knees. Of the children in group 1, boys had thicker apophyseal cartilage than girls at the medial epicondyle, patellar poles and os calcis (P < 0.05). Conclusion: Tendon vascularity may be a normal finding in young children, and mild peri-tendinous vascularity is not uncommon in children 10–13 years of age. Tendon thickness has a linear relationship with age; however cartilage thickness varies across sites and also differs as a function of gender",
author = "Chauvin, {Nancy A.} and Victor Ho-Fung and Diego Jaramillo and Edgar, {J. Christopher} and Weiss, {Pamela F.}",
year = "2015",
month = "8",
day = "7",
doi = "10.1007/s00247-015-3313-0",
language = "English (US)",
volume = "45",
pages = "1344--1354",
journal = "Pediatric Radiology",
issn = "0301-0449",
publisher = "Springer Verlag",
number = "9",

}

Chauvin, NA, Ho-Fung, V, Jaramillo, D, Edgar, JC & Weiss, PF 2015, 'Ultrasound of the joints and entheses in healthy children', Pediatric Radiology, vol. 45, no. 9, pp. 1344-1354. https://doi.org/10.1007/s00247-015-3313-0

Ultrasound of the joints and entheses in healthy children. / Chauvin, Nancy A.; Ho-Fung, Victor; Jaramillo, Diego; Edgar, J. Christopher; Weiss, Pamela F.

In: Pediatric Radiology, Vol. 45, No. 9, 07.08.2015, p. 1344-1354.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Ultrasound of the joints and entheses in healthy children

AU - Chauvin, Nancy A.

AU - Ho-Fung, Victor

AU - Jaramillo, Diego

AU - Edgar, J. Christopher

AU - Weiss, Pamela F.

PY - 2015/8/7

Y1 - 2015/8/7

N2 - Background: Tendon insertion pathologies such as enthesitis and apophysitis in children can result from trauma, overuse syndrome and arthritis. Knowledge of the US appearance of normal joints by age might aid diagnosis of pathologies. Objective: We describe the age-related sonographic features of the elbows, knees and feet in healthy children, providing a reference for the normal appearance of tendon insertions, apophyseal cartilage and bursae. Materials and methods: This is a prospective cross-sectional study of 30 healthy children. Children were grouped according to age: group 1 (4–9 years, n = 11), group 2 (10–13 years, n = 9) and group 3 (14–18 years, n = 10). Children completed pain and function questionnaires and underwent a standardized joint examination by a pediatric rheumatologist. The common extensor, common flexor, quadriceps, patellar and Achilles tendons and plantar fascia insertions were evaluated with gray-scale and power Doppler ultrasound. The anterior elbow, suprapatellar and retrocalcaneal bursae were evaluated for fluid. We measured the apophyseal cartilage thickness at the enthesis. Correlation analyses examined associations between age and tendon thickness. We used ANOVA, with location as a repeated measure, to test for gender differences in cartilage thickness. Results: Children had a median age of 12.4 years and 55% were boys. All 360 entheses appeared normal on gray-scale imaging. There was a strong linear relationship between tendon thickness and age. Tendon vascularity was only present in young children (group 1), in 7/22 (32%) quadriceps tendons. Peri-tendinous power Doppler signal was seen at seven sites: two patellar, four quadriceps and one common flexor tendon, and all these children were in group 2. Suprapatellar bursal fluid <3 mm was detected in 9/60 (15%) knees. Of the children in group 1, boys had thicker apophyseal cartilage than girls at the medial epicondyle, patellar poles and os calcis (P < 0.05). Conclusion: Tendon vascularity may be a normal finding in young children, and mild peri-tendinous vascularity is not uncommon in children 10–13 years of age. Tendon thickness has a linear relationship with age; however cartilage thickness varies across sites and also differs as a function of gender

AB - Background: Tendon insertion pathologies such as enthesitis and apophysitis in children can result from trauma, overuse syndrome and arthritis. Knowledge of the US appearance of normal joints by age might aid diagnosis of pathologies. Objective: We describe the age-related sonographic features of the elbows, knees and feet in healthy children, providing a reference for the normal appearance of tendon insertions, apophyseal cartilage and bursae. Materials and methods: This is a prospective cross-sectional study of 30 healthy children. Children were grouped according to age: group 1 (4–9 years, n = 11), group 2 (10–13 years, n = 9) and group 3 (14–18 years, n = 10). Children completed pain and function questionnaires and underwent a standardized joint examination by a pediatric rheumatologist. The common extensor, common flexor, quadriceps, patellar and Achilles tendons and plantar fascia insertions were evaluated with gray-scale and power Doppler ultrasound. The anterior elbow, suprapatellar and retrocalcaneal bursae were evaluated for fluid. We measured the apophyseal cartilage thickness at the enthesis. Correlation analyses examined associations between age and tendon thickness. We used ANOVA, with location as a repeated measure, to test for gender differences in cartilage thickness. Results: Children had a median age of 12.4 years and 55% were boys. All 360 entheses appeared normal on gray-scale imaging. There was a strong linear relationship between tendon thickness and age. Tendon vascularity was only present in young children (group 1), in 7/22 (32%) quadriceps tendons. Peri-tendinous power Doppler signal was seen at seven sites: two patellar, four quadriceps and one common flexor tendon, and all these children were in group 2. Suprapatellar bursal fluid <3 mm was detected in 9/60 (15%) knees. Of the children in group 1, boys had thicker apophyseal cartilage than girls at the medial epicondyle, patellar poles and os calcis (P < 0.05). Conclusion: Tendon vascularity may be a normal finding in young children, and mild peri-tendinous vascularity is not uncommon in children 10–13 years of age. Tendon thickness has a linear relationship with age; however cartilage thickness varies across sites and also differs as a function of gender

UR - http://www.scopus.com/inward/record.url?scp=84938746292&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84938746292&partnerID=8YFLogxK

U2 - 10.1007/s00247-015-3313-0

DO - 10.1007/s00247-015-3313-0

M3 - Article

C2 - 25744571

AN - SCOPUS:84938746292

VL - 45

SP - 1344

EP - 1354

JO - Pediatric Radiology

JF - Pediatric Radiology

SN - 0301-0449

IS - 9

ER -