Skip to main content
SpringerLink
Log in

Imaging for Knee and Shoulder Injuries

  • Chapter
  • First Online:
Evidence-Based Imaging in Pediatrics

  • 1508 Accesses

Key Points

Knee

■ Knee radiographs of the acutely injured knee in the emergency department are rarely useful for determining therapy, except in patients with any of the following conditions: isolated tenderness of the patella, tenderness at the head of fibula, inability to flex 90°, inability to bear weight both immediately and in the emergency department for a total of four steps, or if the patient is an adult aged 55 or older (strong evidence).

■ Physical examination by an experienced pediatric physician is as accurate as an MRI to diagnose articular cartilage injury, discoid lateral meniscus, anterior cruciate ligament tears, and medial meniscal tear (limited evidence). An MRI is likely more accurate for lateral meniscal tears. However, if the MRI study is interpreted by a physician experienced with the skeletally immature patient, the accuracy could be superior, and additional associated pathology can be identified (limited evidence).

■ An MRI in the setting of osteochondritis dissecans plays an important role in a specific subgroup of patients where it is imperative to assess the integrity of the overlying cartilage (limited evidence).

■ An MRI in the setting of discoid lateral meniscus plays a role in identifying the state of the meniscus in order to assess surgical reparability and also to identify superimposed pathology, such as articular cartilage damage (limited evidence).

Shoulder

■ The use of radiography to evaluate children with first-time acute shoulder trauma is to confirm a fracture or a dislocation and to evaluate the alignment and possible extension into the physeal plate (limited evidence).

■ The use of radiography to evaluate patients with suspected recurrent atraumatic shoulder dislocation is unnecessary in most cases (limited evidence). Furthermore, selective imaging strategies may be able to reduce the number of pre-reduction and/or post-reduction radiographs required in suspected first-time or traumatic shoulder dislocations (limited evidence).

■ Identification of labral and glenohumeral ligament tears is important especially in patients with a history of shoulder dislocations, as they have a high recurrence rate. No dedicated MRI or Magnetic Resonance Arthrogram (MRA) studies have been done in children. However, studies in adults show that MR arthrogram has a high sensitivity and specificity to identify and classify these lesions (limited to moderate evidence). This information is useful to the orthopedic surgeon in preoperative planning of joint stabilization procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Schenck RC Jr., Goodnight JM. J Bone Joint Surg (Am) 1996;78-A(3):439–456.

    Google Scholar 

  2. Obedian RS, Grelsamer RP. Clin Sports Med 1997;16:157–174.

    Article  CAS  PubMed  Google Scholar 

  3. Mitsuoka T, Shino K, Hamada M, Horibe S. Arthoscopy 1999;15(1):20–26.

    Article  CAS  Google Scholar 

  4. Hefti F, Beguiristain J, Krauspe R et al. J Pediatr Orthop Part B 1999;8:231–245.

    Article  CAS  Google Scholar 

  5. Aichroth PJ. Bone Joint Surg (Br) 1971;53(3):440–447.

    CAS  Google Scholar 

  6. Deie M, Ochi M et al. J Pediatr Orthop 2006;26(1):79–82.

    Article  PubMed  Google Scholar 

  7. Cahill BR. J Am Acad Orthop Surg 1995;3:237–247.

    PubMed  Google Scholar 

  8. Cain EL, Clancy WG. Clin Sports Med 2001;20(2):321–342.

    Article  CAS  PubMed  Google Scholar 

  9. Robertson W, Kelly BT, Green DW. Cur Opin Pediatr 2003;15:38–44.

    Article  Google Scholar 

  10. Kelly BT, Green D. Cur Opin Pediatr 2002;14:54–61.

    Article  Google Scholar 

  11. Jordan MR. J Am Acad Orthop Surg 1996;4:191–200.

    PubMed  Google Scholar 

  12. Woods GW, Whelan JM. Clin Sports Med 1990;9(3):695–706.

    CAS  PubMed  Google Scholar 

  13. Andrish JT. J Am Acad Orthop Surg 1996;4:231–237.

    PubMed  Google Scholar 

  14. Singh K, Helms CA, Jacobs MT, Higgins LD. AJR 2006;187:384–387.

    Article  PubMed  Google Scholar 

  15. Carson S, Woolridge D et al. Pediatr Clin N A 2006;53:41–67.

    Article  Google Scholar 

  16. Bishop J, Flatow E. Clin Orthop Relat Res 2005; 432:41–48.

    Article  PubMed  Google Scholar 

  17. Tarkin IS, Morganti CM, et al. Am J Sports Med 2005;33:596–601.

    Article  PubMed  Google Scholar 

  18. Wolff AB, Sethi P et al. J Am Acad Orthop Surg 2006;14(13):715–725.

    PubMed  Google Scholar 

  19. Morag Y, Jacobson JA et al. Radiographics 2006;26:1045–1065.

    Article  PubMed  Google Scholar 

  20. Emery K. Clin Sports Med 2006;25:543–568.

    Article  PubMed  Google Scholar 

  21. Yawn BP, Amadio P, Harmsen WS, Hill J, Ilstrup D et al. J Trauma 2000;48(4):716–723.

    Article  CAS  PubMed  Google Scholar 

  22. Adirim TA, Cheng TL. Sports Med 2003;33(1):75–81.

    Article  PubMed  Google Scholar 

  23. Burt CW, Overpeck MD. Ann Emerg Med 2001;37(3):301–306.

    Article  CAS  PubMed  Google Scholar 

  24. Gomol, A. Orthopedics 2007;30:487.

    Google Scholar 

  25. Connolly B, Babyn PS. Can Assoc Rad J 1996;47(5):347–354.

    CAS  Google Scholar 

  26. Dietch J et al. Am J Sports Med 2003;31(5):758–763.

    Google Scholar 

  27. Tuite M. Magn Reson Imaging Clin N Am 2003; 11(3):207–219.

    Article  PubMed  Google Scholar 

  28. Woolf AD, Pfleger B. Bull World Health Organ 2003;81(9):646–656.

    PubMed  Google Scholar 

  29. National Center for Health Statistics (US). National hospital ambulatory medical care survey: 2001. Hyattsville, MD: National Center for Health Statistics (US), 2003.

    Google Scholar 

  30. Kocher MS, Dicanzio J, Zurakowski D, Micheli LJ. Am J Sports Med 2001;29(3):292–296.

    CAS  PubMed  Google Scholar 

  31. Luhmann S, Schootman M, Gordon JE, Wright RW. J Bone Joint Surg 2005;87-A(3):497–502.

    Article  Google Scholar 

  32. Stanitski CL. Am J Sports Med 1998;26(1):2–6.

    CAS  PubMed  Google Scholar 

  33. Matteucci MJ, Roos JA. J Emerg Med 2003;24(2):147–150.

    Article  PubMed  Google Scholar 

  34. Seaberg DC, Yealy DM, Lukens T, Auble T, Mathias S. Ann Emerg Med 1998;32(1):8–13.

    Article  CAS  PubMed  Google Scholar 

  35. Khine H, Dorfman DH, Avner JR. Ped Emerg Care 2001;17(6):401–404.

    Article  CAS  Google Scholar 

  36. Moore B. J Emerg Med 2005;28(3): 257–261.

    Article  PubMed  Google Scholar 

  37. Stiell IG, Wells GA, Hoag RH, Sivilotti ML, Cacciotti TF, Verbeek PR et al. JAMA 1997;278(23):2075–2079.

    Article  CAS  PubMed  Google Scholar 

  38. Fagan DJ, Davies S. Injury 2000;31(9):723–727.

    Article  CAS  PubMed  Google Scholar 

  39. Seaberg DC, Jackson R. Am J Emerg Med 1994;12(5):541–543.

    Article  CAS  PubMed  Google Scholar 

  40. Stiell IG, Greenberg GH, Wells GA, McKnight RD, Cwinn AA, Cacciotti T et al. Ann Emerg Med 1995;26(4):405–413.

    Article  CAS  PubMed  Google Scholar 

  41. Weber JE, Jackson RE, Peacock WF, Swor RA, Carley R et al. Ann Emerg Med 1995;26(4):429–433.

    Article  CAS  PubMed  Google Scholar 

  42. Stiell IG, Greenberg GH, Wells GA, McDowell I, Cwinn AA, Smith NA et al. JAMA 1996;275(8):611–615.

    Article  CAS  PubMed  Google Scholar 

  43. Hollingworth W. In Medina LS, Blackmore CC (eds): Evidence Based Imaging, New York: Springer, 2006;273–293.

    Google Scholar 

  44. Bachmann LM, Haberzeth S, Steurer J, ter Riet G. Ann Intern Med 2004;140(2):121–124.

    PubMed  Google Scholar 

  45. Tepper KB, Ireland ML. Instr Course Lect 2003;52:667–676.

    PubMed  Google Scholar 

  46. Bulloch B, Neto G, Plint A, Lim R, Lidman P, Reed M et al. Ann Emerg Med 2003;42(1):48–55.

    Article  PubMed  Google Scholar 

  47. Eren OT. Arthroscopy 2003;19(8):850–854.

    Article  PubMed  Google Scholar 

  48. De Smet A, Ilahi OA, Graf BK. Skeletal Radiol 1997;26:463–467.

    Article  PubMed  Google Scholar 

  49. Hughes JA, Cook JA, Churchill MA, Warren ME. Pediatr Radiol 2003;33:410–417.

    PubMed  Google Scholar 

  50. Pill SG, Ganley TJ et al. J Pediatr Orthop 2003;23:102–108.

    Article  PubMed  Google Scholar 

  51. Bohndorf K. Eur Radiol 1998;8:103–112.

    Article  CAS  PubMed  Google Scholar 

  52. Yoshida S, Ikata T, Takai H et al. Clin Orthop Rel Res 1998; 46: 162–170.

    Google Scholar 

  53. Conrad JM, Stanitski CL. Am J Sports Med 2003;31(5):777–778.

    PubMed  Google Scholar 

  54. Cepero S, Ullot R, Sastre S. J Pediatr Orthop Part B 2005;14:24–29.

    Google Scholar 

  55. Williams JS, Bush-Joseph CH, Bach BR. Am J Knee Surg 1998;11(4): 221–232.

    PubMed  Google Scholar 

  56. Milgram JW. Radiology 1978;126:305–311.

    CAS  PubMed  Google Scholar 

  57. Jerosch J, Hoffstetter L, Reer R. Acta Orthop Belg 1996;62(2):83–89.

    CAS  PubMed  Google Scholar 

  58. Wall E, Von Stein D. Orthop Clin N Am 2003;34:341–353.

    Article  Google Scholar 

  59. O’Connor MA, Palaniappan M, Khan N, Bruce CE. J Bone Joint Surg (Br) 2002;84-B:258–262.

    Article  Google Scholar 

  60. Kocher MS, Micheli Lj, Yaniv M et al. Am J Sports Med 2001; 29(5): 562–566.

    CAS  PubMed  Google Scholar 

  61. Linden B. J Bone Joint Surg (Am) 1977;59:769–776.

    CAS  Google Scholar 

  62. Di Paola J, Nelson DW, Colvine MR. Arthoscopy 1991;7:101–104.

    Article  CAS  Google Scholar 

  63. Kim S-J, Moon S-H et al. Arthroscopy 2000;16(5): 511–516.

    Article  CAS  PubMed  Google Scholar 

  64. Rohren EM, Kosarek FJ, Helms CA. Skeletal Radiol 2001;30:316–320.

    Article  CAS  PubMed  Google Scholar 

  65. Kim JM. J Korean Orthop Assoc 1997;32(3):658–661.

    Google Scholar 

  66. Hamada M, Shino K, Kawano K, Araki Y, Matsui Y et al. Arthroscopy 1994;10(6):645–653.

    Article  CAS  PubMed  Google Scholar 

  67. Araki Y, Ashikaga R, Fujii K, Ishida O, Hamada M, Ueda J et al. Eur J Rad 1998; 27:153–160.

    Article  CAS  Google Scholar 

  68. Bin SI, Kin JC, Kim JM, Park SS, Han YK. Knee Surg Sports Traumatol Arthros 2002; 10:218–222.

    Google Scholar 

  69. Raber DA, Friederich NF, Hefti F. J Bone Joint Surg (Am) 1998;80-A(11):1579–1586.

    Google Scholar 

  70. Ryu KN, Kim AS, Ahn JW et al. AJR 1998;171:963–967.

    CAS  PubMed  Google Scholar 

  71. Aichroth PM, Patel DV. J Bone Joint Surg (Br) 1991;73-B:932–936.

    Google Scholar 

  72. Rivara F, Parish RA et al. Pediatrics 1986;78(5):803–807.

    CAS  PubMed  Google Scholar 

  73. te Slaa RL, Wijffels MP, Marti RK. Eur J Emerg Med 2003;10(1):58–61.

    Article  PubMed  Google Scholar 

  74. Fraenkel L, Lavalley M, Felson D. Am J Emerg Med 1998;16(6):560–563.

    Article  CAS  PubMed  Google Scholar 

  75. Marans HJ, Angel KR et al. J Bone Joint Surg 1992;74A:1242–1244.

    Google Scholar 

  76. Postacchini F, Gumina S et al. J Shoulder Elbow Surg 2000;9(6):470–474.

    Article  CAS  PubMed  Google Scholar 

  77. Hendey GW. Ann Emerg Med 2000;36(2):108–113.

    Article  CAS  PubMed  Google Scholar 

  78. Harvey RA, Trabulsy ME, Roe L. Am J Emerg Med 1992;10(2):149–151.

    Article  CAS  PubMed  Google Scholar 

  79. Hendey GW, Kinlaw K. Ann Emerg Med 1996;28(4):399–402.

    Article  CAS  PubMed  Google Scholar 

  80. Shuster M, Abu-Laban RB, Boyd J. Am J Emerg Med 1999;17(7):653–658.

    Article  CAS  PubMed  Google Scholar 

  81. Demirhan M, Akpinar S, Atalar AC, Akman S, Akalin Y. Injury 1998;29(7):525–528.

    Article  CAS  PubMed  Google Scholar 

  82. Waldt S, Burkart A, Imhoff AB, Bruegel M et al. Radiology 2005; 237:578–583.

    Article  PubMed  Google Scholar 

  83. Palmer WE, Brown JH, Rosenthal Di. Radiology 1994 190: 645–651.

    CAS  PubMed  Google Scholar 

  84. Palmer WE, Carlowitz PL. Radiology 1995, 197:819–825.

    CAS  PubMed  Google Scholar 

  85. Chandnani VP, Gagliardi A, Murnane TG et al. Radiology 1995: 196:27–32.

    CAS  PubMed  Google Scholar 

  86. Szucs PA, Richman PB, Mandell M. Acad Emerg Med 2001;8(2):112–116.

    Article  CAS  PubMed  Google Scholar 

  87. Kec RM, Richman PB, Szucs PA, Mandell M, Eskin B. Acad Emerg Med 2003;10(2):146–150.

    PubMed  Google Scholar 

  88. Ketelslegers E, Collard X, Vande Berg B, Danse E, El-Gariani A, Poilvache P et al. Eur Radiol 2002;12(5):1218–1220.

    Article  PubMed  Google Scholar 

  89. Emparanza JI, Aginaga JR. Ann Emerg Med 2001;38(4):364–368.

    Article  CAS  PubMed  Google Scholar 

  90. Tigges S, Pitts S, Mukundan S, Jr., Morrison D, Olson M, Shahriara A. AJR Am J Roentgenol 1999;172(4):1069–1071.

    CAS  PubMed  Google Scholar 

  91. Richman PB, McCuskey CF, Nashed A, Fuchs S, Petrik R, Imperato M et al. J Emerg Med 1997;15(4):459–463.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Miami Children’s Hospital, 33155, Miami, FL, USA

    Ricardo Restrepo (Pediatric Radiologist, Fellowship Director) & Christopher Schettino MD

Authors
  1. Ricardo Restrepo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Schettino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ricardo Restrepo .

Editor information

Editors and Affiliations

  1. Dept. Radiology, Miami Children's Hospital, SW 114 Street 7420, Miami , 33156, U.S.A.

    L. Santiago Medina

  2. Dept. Radiology, Riley Children's Hospital, Barnhill Drive 702 , Indianapolis, 46202-5200, U.S.A.

    Kimberly E. Applegate

  3. Harborview Medical Center, University of Washington, Ninth Avenue 325, Seattle, 98104-2499, U.S.A.

    C. Craig Blackmore

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Restrepo, R., Schettino, C. (2010). Imaging for Knee and Shoulder Injuries. In: Medina, L., Applegate, K., Blackmore, C. (eds) Evidence-Based Imaging in Pediatrics. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0922-0_19

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-0922-0_19

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-0921-3

  • Online ISBN: 978-1-4419-0922-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation