Ultrasound of the joints and entheses in healthy children

Abstract

Tendon vascularity may be a normal finding in young children, and mild peri-tendinous vascularity is not uncommon in children 10-13 years of age. Tendon thickness has a linear relationship with age; however cartilage thickness varies across sites and also differs as a function of gender.

What’s new in musculoskeletal ultrasound in pediatric rheumatology?

“…Entheses were also evaluated in healthy volunteers of pediatric ages. Still there are no references for age and gender-related normal appearance of tendon insertions, vascularity expected at the entheses in the growing child [20]. Furthermore it remains normal US enthesis in children to be defined.…”

“…Small amounts of sinovial fluid may also be identified in some normal joints in children.Visible fluid accumulation was demonstrated on MSUS in the knee recesses, at the MCP and PIP synovial recesses and/or the flexor tendon sheaths [13,19]. Fluid within the suprapatellar recess of the knee (less than 3 mm in thickness) was commonly found in almost all age groups and better visualized during contraction of the quadriceps muscles [13,20]. None of the healthy children investigated showed joint hip or anterior elbow joint fluid [19][20][21].…”

“…Fluid within the suprapatellar recess of the knee (less than 3 mm in thickness) was commonly found in almost all age groups and better visualized during contraction of the quadriceps muscles [13,20]. None of the healthy children investigated showed joint hip or anterior elbow joint fluid [19][20][21].…”

“…The characteristic US appearance of normal tendons, muscles and ligaments is similar with that of adults. But unlike adults, normal tendons may demonstrate visible blood vessels with Dopppler in young children and mild peritendinous vascularity may be seen in children 10-13 years of age [20].…”

Evaluation and Treatment of Childhood Enthesitis-Related Arthritis

“…Identification of abnormalities at the entheses in children, however, mandates knowledge of the appearance of cartilage and tendons in growing children. Two studies demonstrated that tendon thickness increases with age and that a small degree of cartilage vascularity is normal, especially in younger children [14,15]. As additional studies are performed to further our understanding of the normal appearance of pediatric cartilage and tendons on USD, we will hopefully be able to more precisely and accurately identify enthesitis using USD as part of routine clinical practice.…”