Skeletal Development of the Proximal Humerus in the Pediatric Population: MRI Features

Kwong, Steven; Kothary, Shefali; Poncinelli, Leonardo Lobo

doi:10.2214/ajr.13.10711

Cited by 49 publications

(44 citation statements)

References 18 publications

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“…On the other hand, Flecker (17) argues against the existence of a third ossification center. Kwong et al (5) further speculate that the medial humeral head ossification center grows anteriorly into the lesser tuberosity. Before its complete ossification, the anterior margin of the lesser tuberosity appears as a sliver of intermediate-signal-intensity cartilage, deep to the insertion of the subscapularis tendon (Fig 14).…”

Section: Humerus Ossification Centersmentioning

confidence: 99%

“…At MR imaging, the metaphyseal stripe is clearly seen in the shoulder because it surrounds the entire proximal humerus and, less commonly, the distal clavicle and acromion. The metaphyseal stripe in the proximal humerus appears within the first few months of life and can be seen in patients up to approximately 14 years of age (5). It manifests at MR imaging as a smooth, circumferential area with high signal intensity, measuring 1-2 mm in width and separating the hypointense cortex from the hypointense fibrous periosteum (Fig 19).…”

Section: Metaphyseal Stripementioning

confidence: 99%

“…This finding may be appreciated at MR imaging as a region of nonconfluent low signal intensity on T1-weighted images and high signal intensity on fluid-sensitive images (Fig 21). The signal intensity may be either linear or patchy in appearance, eventually transforming into a linear band abutting the proximal humeral growth plate (5). The residual red marrow in the proximal metaphysis should not be mistaken for marrow edema secondary to a fracture or little league shoulder.…”

Section: Metaphyseal Marrow Signalmentioning

confidence: 99%

“…Although the sequential changes in the pediatric shoulder have been documented at radiography, there has been a paucity of studies describing the magnetic resonance (MR) imaging features of the musculoskeletal development of the shoulder (4,5). However, an accurate understanding of the normal maturation process, its radiologic manifestations, and associated imaging pitfalls is crucial in the evaluation of the pediatric shoulder.…”

Section: Introductionmentioning

confidence: 99%

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Normal Skeletal Maturation and Imaging Pitfalls in the Pediatric Shoulder

Zember¹,

Rosenberg²,

Kwong³

et al. 2015

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A growing number of magnetic resonance (MR) imaging studies of the shoulder are being performed as a result of greater and earlier participation of children and adolescents in competitive sports such as softball and baseball. However, scant information is available regarding the MR imaging features of the normal sequential development of the shoulder. The authors discuss the radiographic and MR imaging appearances of the normal musculoskeletal maturation patterns of the shoulder, with emphasis on (a) development of secondary ossification centers of the glenoid (including the subcoracoid and peripheral glenoid ossification centers); (b) development of preossification and secondary ossification centers of the humeral head and the variable appearance and number of the secondary ossification centers of the distal acromion, with emphasis on the formation of the os acromiale; (c) development of the growth plates, glenoid bone plates, glenoid bare area, and proximal humeral metaphyseal stripe; and (d) marrow signal alterations in the distal humerus, acromion, and clavicle. In addition, the authors discuss various imaging interpretation pitfalls inherent to the normal skeletal maturation of the shoulder, examining clues that may help distinguish normal development from true disease (eg, osteochondral lesions, labral tears, abscesses, fractures, infection, tendon disease, acromioclavicular widening, and os acromiale). Familiarity with the timing, location, and appearance of maturation patterns in the pediatric shoulder is crucial for correct image interpretation.

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Section: Humerus Ossification Centersmentioning

confidence: 99%

Section: Metaphyseal Stripementioning

confidence: 99%

Section: Metaphyseal Marrow Signalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Normal Skeletal Maturation and Imaging Pitfalls in the Pediatric Shoulder

Zember¹,

Rosenberg²,

Kwong³

et al. 2015

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“…MRI indeed offers a remarkable insight into the dynamic process of skeletal growth and maturation, as demonstrated by an increasing number of studies in children and adolescents in recent years [15][16][17][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. The vast majority of these studies focused on the clavicle, hand and wrist, producing large 6 reference databases for different populations.…”

Section: Introductionmentioning

confidence: 99%

Applicability of T1-weighted MRI in the assessment of forensic age based on the epiphyseal closure of the humeral head

Ekizoğlu¹,

İnci

Örs

et al. 2018

Int J Legal Med

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This work investigates the value of magnetic resonance imaging analysis of proximal epiphyseal fusion in research examining the growth and development of the humerus and its potential utility in establishing forensic age estimation. In this study, 428 proximal humeral epiphyses (patient age, 12-30 years) were evaluated with T1-weighted turbo spin echo (T1 TSE) sequences in coronal oblique orientation on shoulder MRI images. A scoring system was created following a combination of the Schmeling and Kellinghaus methods. Spearman's rank correlation analysis revealed a significant positive relationship between age and ossification stage of the proximal humeral epiphysis (all subjects: rho = 0.664, p < 0.001; males: 0.631, p < 0.001; females: rho = 0.651, p < 0.001). The intra- and inter-observer reliability assessed using Cohen's kappa statistic was κ = 0.898 and κ = 0.828, respectively. The earliest age of epiphysis closure was 17 years for females and 18 years for males. MRI of the proximal humeral epiphysis can be considered advantageous for forensic age estimation of living individuals in a variety of situations, ranging from monitoring public health to estimating the age of illegal immigrants/asylum seekers, minors engaged in criminal activities, and illegal participants in competitive sports, without the danger of radiation exposure.

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Transient neonatal shoulder paralysis causes early osteoarthritis in a mouse model

Forrester

Fang

Jacobsen

et al. 2021

Journal Orthopaedic Research

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Neonatal brachial plexus palsy (NBPP) occurs in approximately 1.5 of every 1,000 live births. The majority of children with NBPP recover function of the shoulder. However, the long‐term risk of osteoarthritis (OA) in this population is unknown. The purpose of this study was to investigate the development of OA in a mouse model of transient neonatal shoulder paralysis. Neonatal mice were injected twice per week for 4 weeks with saline in the right supraspinatus muscle (Saline, control) and botulinum toxin A (BtxA, transient paralysis) in the left supraspinatus muscle, and then allowed to recover for 20 or 36 weeks. Control mice received no injections, and all mice were sacrificed at 24 or 40 weeks. BtxA mice exhibited abnormalities in gait compared to controls through 10 weeks of age, but these differences did not persist into adulthood. BtxA shoulders had decreased bone volume (−9%) and abnormal trabecular microstructure compared to controls. Histomorphometry analysis demonstrated that BtxA shoulders had higher murine shoulder arthritis scale scores (+30%), and therefore more shoulder OA compared to controls. Articular cartilage of BtxA shoulders demonstrated stiffening of the tissue. Compared with controls, articular cartilage from BtxA shoulders had 2‐fold and 10‐fold decreases in Dkk1 and BMP2 expression, respectively, and 3‐fold and 14‐fold increases in Col10A1 and BGLAP expression, respectively, consistent with established models of OA. In summary, a brief period of paralysis of the neonatal mouse shoulder was sufficient to generate early signs of OA in adult cartilage and bone.

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Skeletal Development of the Proximal Humerus in the Pediatric Population: MRI Features

Abstract: The postnatal skeletal development of the proximal humerus in the pediatric population follows distinctive sequential patterns of maturation, which can serve as a guideline for interpreting MRI studies in children.

Cited by 49 publications

References 18 publications

Normal Skeletal Maturation and Imaging Pitfalls in the Pediatric Shoulder

Normal Skeletal Maturation and Imaging Pitfalls in the Pediatric Shoulder

Applicability of T1-weighted MRI in the assessment of forensic age based on the epiphyseal closure of the humeral head

Transient neonatal shoulder paralysis causes early osteoarthritis in a mouse model

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