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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
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Publikationsdatum:
24. August 2017 (online)

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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
 

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