Rheumatology International

, Volume 39, Issue 6, pp 1007–1018 | Cite as

Age dependent ultrasound B-mode findings of the elbow joint in healthy children and adolescents

  • Ralf TrauzeddelEmail author
  • Hartwig Lehman
  • Ralf Felix Trauzeddel
  • Maria Haller
  • Katharina Palm-Beden
  • Gerd Ganser
  • Rainer Berendes
  • Christine Nirschl
  • Antje Nimtz-Talaska
  • Manuela Krumrey-Langkammerer
  • Philipp Schoof
  • Daniel Windschall


Due to maturation of joints, various changes take place, not only in the field of paediatric rheumatology but also in paediatric orthopaedics musculoskeletal ultrasound plays an important role in both the diagnosis and the follow-up of diseases in this field. To differentiate between physiological and pathological findings, the knowledge of reference values of joint structures is indispensable. The objective was to define B-mode ultrasound age- and sex-related reference values for the elbow joint in healthy children and adolescents during maturation. In a cross-sectional, multicentre ultrasound study we examined both sides of the elbow joints of 437 healthy children and adolescents (194 boys/243 girls) being between one and less than 18 years old. The children were classified into six equal age groups and divided according to their gender. We measured the distance between the outer margin of the joint capsule and the bone surface to define the bone-capsule distance (BCD), the thickness of the joint cartilage as well as the thickness of the joint capsule. The bone–capsule junction zone and the shape of the joint capsule were analysed qualitatively. The bone capsule distance and the capsule thickness increased with age. In contrast, the joint cartilage thickness decreased. In most cases the junction zone was peaked. The joint capsule showed mostly a concave shape. Intra- and interobserver reliabilities were good. We propose B-mode ultrasound age- and sex-related reference values for the elbow joint in a large number of healthy children and adolescents for the first time. By applying these standard values to the ultrasound examination of the elbow joint, it may be possible to achieve greater certainty in the diagnosis of pathological processes.


Musculoskeletal ultrasound Elbow joint Healthy children Reference values Paediatric rheumatology Paediatric orthopaedics 



The authors would like to thank all study volunteers and their parents. All listed authors have provided a significant contribution in this study by participating in design, patient recruitment and assessment, data entering, data analysis as well as preparing the manuscript.

Author contributions

RT, HL, RFT, MH, KP-B, GG, RB, CN, AN-T, MK-L, PS, DW: patient examination, ultrasound examination, cooperation and supplementation of the article. RFT: patient examination, ultrasound examination, cooperation and supplementation of the article and statistics.


This study was funded by Pfizer Pharma (Grant number WI 171287).

Compliance with ethical standards

Conflict of interest

All authors declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants/parents included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Pediatric and Adolescent MedicineHelios Hospital Berlin-BuchBerlinGermany
  2. 2.Department of PediatricsUniversity Medicine GießenGiessenGermany
  3. 3.Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK)Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
  4. 4.GundelfingenGermany
  5. 5.Department of Paediatric and Adolescent Rheumatology, North-Western German Centre for RheumatologySt. Josef-Stift SendenhorstSendenhorstGermany
  6. 6.St. Marien Children’s HospitalLandshutGermany
  7. 7.Klinikum Burgenlandkreis GmbH NaumburgNaumburgGermany
  8. 8.Frankfurt/OderGermany
  9. 9.German Center for Pediatric and Adolescent RheumatologyGarmisch-PartenkirchenGermany
  10. 10.MunichGermany
  11. 11.Department of PediatricsAsklepios Hospital WeißenfelsWeissenfelsGermany

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