Age dependent ultrasound B-mode findings of the elbow joint in healthy children and adolescents
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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.
KeywordsMusculoskeletal 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.
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.
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 was obtained from all individual participants/parents included in the study.
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