Normal Skeletal Maturation and Imaging Pitfalls in the Pediatric Shoulder

Zember, Jonathan; Rosenberg, Zehava Sadka; Kwong, Steven; Kothary, Shefali; Bedoya, Maria A.

doi:10.1148/rg.2015140254

Cited by 76 publications

(53 citation statements)

References 27 publications

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“…In general, the most common os acromiale is the large, relatively triangular mesoacromion, which forms an interface with the acromion in proximity to the acromioclavicular joint (ACJ), while a less common os acromiale, the preacromion, is noted at the distal tip of the acromion. There is a strong relationship between os acromiale and race, while the correlation between os acromiale and rotator cuff tear is full of controversies.…”

Section: Methods Of Searchingmentioning

confidence: 99%

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Os Acromiale: Reviews and Current Perspectives

You

Frostick

Zhang

et al. 2019

Orthopaedic Surgery

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Os acromiale is a developmental defect which results from the lack of an osseous union between the ossification centers of the acromion, leading to the fibrocartilaginous tissue connection. The prevalence of os acromiale is 1% to 15%, and is quite common in the African American population. Os acromiale in adults is easily diagnosed by symptoms and X‐ray, particularly on the axillary view; however, the differential diagnosis of adolescents may require MRI or SPECT–CT. Generally, nonoperative therapy for symptomatic os acromiale should be started, including physiotherapy, nonsteroidal anti‐inflammatory drugs, and injections. Surgical treatment is indicated after failed conservative treatment. In symptomatic patients with fixable acromiale, the tension band technique should be used to make the anterior aspect of the acromion elevated from the humerus head. In patients with small fragments which are unsuitable for reattachment, excision might be the best therapeutic option and lead to good outcomes. Whether using internal fixation or resection, the arthroscopic technique results in a better outcome and fewer complications, especially in older patients or athletes with overhead movement, because of the high incidence of shoulder impingement or rotator cuff tears which can be treated concurrently.

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Section: Methods Of Searchingmentioning

confidence: 99%

“…In an adolescent patient presenting with a painful shoulder, it may be difficult to distinguish a normally developing acromion with a secondary ossification center from the early formation of an os acromiale on the basis of age alone. Therefore, MRI and SPECT–CT are receiving more and more attention. Winfeld et al .…”

Section: Methods Of Searchingmentioning

confidence: 99%

Os Acromiale: Reviews and Current Perspectives

You

Frostick

Zhang

et al. 2019

Orthopaedic Surgery

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“…MRI was used to study growth in the pediatric shoulder, where the ability to study 318 changes in bone and soft tissues simultaneously was highlighted (28). An additional 319…”

Section: Inter-tissue Differences In Growth 251mentioning

confidence: 99%

Tissue-specific changes in size and shape of the ligaments and tendons of the porcine knee during post-natal growth

Cone

Piercy

Lambeth

et al. 2019

Preprint

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23Prior studies have analyzed growth of musculoskeletal tissues between species or 24 across body segments; however, little research has assessed the differences in similar 25 tissues within a single joint. Here we studied changes in the length and cross-sectional 26 area of four ligaments and tendons, (anterior cruciate ligament, patellar tendon, medial 27 collateral ligament, lateral collateral ligament) in the tibiofemoral joint of female 28Yorkshire pigs through high-field magnetic resonance imaging throughout growth. 29Tissue lengths increased by 4-to 5-fold from birth to late adolescence across the 30 tissues while tissue cross-sectional area increased by 10-20-fold. The anterior cruciate 31 ligament and lateral collateral ligament showed allometric growth favoring change in 32 length over change in cross-sectional area while the patellar tendon and medial 33 collateral ligament grow in an isometric manner. Additionally, changes in the length and 34 cross-sectional area of the anterior cruciate ligament did not increase as much as in the 35 other ligaments and tendon of interest. Overall, these findings suggest that 36 musculoskeletal soft tissue morphometry can vary within tissues of similar structure and 37 within a single joint during post-natal growth. 38 39 Joints within the musculoskeletal system consist of a complex combination of 41 active and passive tissues including ligaments and tendons that have specific 42 morphometric and mechanical properties enabling force generation and movement. 43Many studies have investigated early pre-natal development of ligaments and tendons 44(1-6). In addition, the structure, function, and biochemical makeup of ligaments and 45 tendons undergo major changes throughout both pre-natal and post-natal growth (7-11). 46Specific changes include increasing macroscale size and mechanical stiffness and 47 to the tibial insertion site (17). Interestingly, differences in growth rate coefficients were 63 found between the proximal bones of the hindlimb (femur) and forelimb (humerus) in the 64 porcine model through 3 months of age but not between the distal bones of the same 65 limbs (tibia and radius) (18). The same study found that both the tibia and femur 66 experienced more rapid change in bone area relative to bone length (allometric growth), 67 although the same trend was not found in the humerus (18). A study in human growth 68 insertion of the PT, and some insertion sites extended beyond the field of view of the 131 MRI scans for larger specimens. As such, the location of these insertion sites were 132 measured at the edge of the insertion most proximal to the joint center since this 133 landmark could be consistently identified in all specimens. The insertion was 134 determined as the centroid of points collected around the tissue at this location along 135 the tissue length. Furthermore, to avoid variability caused by the changing CSA near 136 the bony insertions, our CSA analysis was restricted to the midsubstance of the tissues. 137Specifically, the CSA was measured...

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“…One of the least studied epiphyseal areas in the human skeleton is the proximal humeral epiphysis, and only a few studies have investigated the relationship between age and epiphyseal closure [36,37,38,39,40,41,42]. In past anatomical studies of the Lisbon, Coimbra, Bosnian, and McKern skeletal collections, the earliest fusion observed in proximal humeral epiphysis evaluations was reported to occur at an age of 17-19 years in males and 17 years in females [40,41,42,43].…”

Section: Introductionmentioning

confidence: 99%

Forensic age diagnostics by magnetic resonance imaging of the proximal humeral epiphysis

Ekizoğlu¹,

İnci

Örs

et al. 2018

Int J Legal Med

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The most commonly used radiological method for age estimation of living individuals is X-ray. Computed tomography is not commonly used due to high radiation exposure, which raises ethical concerns. This problem can be solved with the use of magnetic resonance imaging (MRI), which avoids the use of ionizing radiation. The purpose of the present study was to evaluate the utility of MRI analysis of the proximal humeral epiphyses for forensic age estimations of living individuals. In this study, 395 left proximal humeral epiphyses (patient age 12-30 years) were evaluated with fast-spinecho proton density-weighted image (FSE PD) sequences in a coronal oblique orientation on shoulder MRI images. A five-stage scoring system was used following the method of Dedouit et al. The intra-and interobserver reliabilities assessed using Cohen's kappa statistic were κ = 0.818 and κ = 0.798, respectively. According to this study, stage five first appeared at 20 and 21 years of age in males and females, respectively. These results are not directly comparable to any other published study due to the lack of MRI data on proximal humeral head development. These findings may provide valuable information for legally important age thresholds using shoulder MRI. The current study demonstrates that MRI of the proximal humerus can support forensic age estimation. Further research is needed to establish a standardized protocol that can be applied worldwide.

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Normal Skeletal Maturation and Imaging Pitfalls in the Pediatric Shoulder

Cited by 76 publications

References 27 publications

Os Acromiale: Reviews and Current Perspectives

Os Acromiale: Reviews and Current Perspectives

Tissue-specific changes in size and shape of the ligaments and tendons of the porcine knee during post-natal growth

Forensic age diagnostics by magnetic resonance imaging of the proximal humeral epiphysis

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