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Upper limb: Shoulder and Arm

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Pediatric Musculoskeletal Ultrasonography

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Abstract

The shoulder is one of the most complex joints in the body. Ultrasound represents a valuable imaging modality to obtain a comprehensive depiction of the main anatomical structure of the shoulder, including joint recesses, bursae, ligaments, muscles, and tendons. Furthermore, it allows dynamic scanning during joint motion and muscle contraction and assists in guiding minimally invasive interventional procedures. A sound knowledge of its anatomy and the use of a proper scanning technique are essential to perform an accurate shoulder examination with ultrasound.

The spectrum of pathologies potentially affecting the shoulder is quite different in the children age group compared to adults. This chapter describes the ultrasound anatomy and the most common pathologies of the shoulder, which are of interest to pediatric rheumatologists. Special emphasis will be placed to distinguish normal anatomy from imaging pitfalls related to skeletal maturation.

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References

  1. Babini JC, Gusis SE, Babini SM, Cocco JA. Superolateral erosions of the humeral head in chronic inflammatory arthropathies. Skelet Radiol. 1992;21:515–7.

    Article  CAS  Google Scholar 

  2. Backhaus M, Burmester GR, Gerber T, Grassi W, Machold KP, Swen WA, et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis. 2001;60:641–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Balogh B, Frühwald F, Neuhold A, Wicke L, Firbas W. Sonoanatomy of the shoulder. Acta Anat. 1986;126:132–5.

    Article  CAS  PubMed  Google Scholar 

  4. Beggs I, Bianchi S, Bueno A, Cohen M, Court-Payen M, Grainger A, Kainberger F, Klauser A, Martinoli C, McNally E, O’Connor PJ, Peetrons P, Reijnierse M, Remplik P, Silvestri E. European society of musculo skeletal radiology: Musculoskeletal ultrasound technical guidelines. Insights Imaging. 2010;1:99–141.

    Article  Google Scholar 

  5. Bianchi S, Martinoli C. Ultrasound of the musculoskeletal system: Springer; 2007. ISBN 978-3-540-42267-9.

    Google Scholar 

  6. Braithwaite KA, Marshall KW. The skeletally immature and newly mature throwing athlete. Radiol Clin N Am. 2016;54:841–55.

    Article  PubMed  Google Scholar 

  7. Chauvin NA, Jaimes C, Laor T, Jaramillo D. Magnetic resonance imaging of the pediatric shoulder. Magn Reson Imaging Clin N Am. 2012;20:327–47.

    Article  PubMed  Google Scholar 

  8. Colebatch-Bourn AN, Edwards CJ, Collado P, D’Agostino MA, Hemke R, Jousse-Joulin S, Maas M, Martini A, Naredo E, Østergaard M, Rooney M, Tzaribachev N, van Rossum MA, Vojinovic J, Conaghan PG, Malattia C. EULAR-PReS points to consider for the use of imaging in the diagnosis and management of juvenile idiopathic arthritis in clinical practice. Ann Rheum Dis. 2015;74:1946–57.

    Article  CAS  PubMed  Google Scholar 

  9. Collado P, Vojinovic J, Nieto JC, Windschall D, Magni-Manzoni S, Bruyn GA, Iagnocco A, D’agostino MA, Naredo E. Omeract ultrasound pediatric group. Toward standardized musculoskeletal ultrasound in pediatric rheumatology: normal age-related ultrasound findings. Arthritis Care Res. 2016;68:348–56.

    Article  Google Scholar 

  10. Cross KP, Warkentine FH, Kim IK, Gracely E, Paul RI. Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Acad Emerg Med. 2010;17:687–93.

    Article  PubMed  Google Scholar 

  11. de la Puente R, Boutin RD, Theodorou DJ, Hooper A, Schweitzer M, Resnick D. Post-traumatic and stress-induced osteolysis of the distal clavicle: MR imaging findings in 17 patients. Skelet Radiol. 1999;28:202208.

    Google Scholar 

  12. Eksioglu F, Altinok D, Uslu MM, Gudemez E. Ultrasonographic findings in pediatric fractures. Turk J Pediatr. 2003;45:136–40.

    PubMed  Google Scholar 

  13. Hubner U, Schlicht W, Outzen S, Barthel M, Halsband H. Ultrasound in the diagnosis of fractures in children. J Bone Joint Surg Br. 2000;82:1170–3.

    Article  CAS  PubMed  Google Scholar 

  14. Jaramillo D, Kleinman P. Special aspects of musculoskeletal imaging in children. In: Hodler J, Zollikofer CL, Von Schulthess GK, editors. Musculoskeletal diseases 2009–2012. Milan: Springer; 2009. p. 158–65.

    Chapter  Google Scholar 

  15. Katz R, Landman J, Dulitzky F, Bar-Ziv J. Fracture of the clavicle in the newborn. An ultrasound diagnosis. J Ultrasound Med. 1988;7:21–3.

    Article  CAS  PubMed  Google Scholar 

  16. Kayser R, Mahlfeld K, Heyde C, Grasshoff H. Ultrasonographic imaging of fractures of the clavicle in newborn infants. J Bone Joint Surg Br. 2003;85:115–6.

    Article  PubMed  Google Scholar 

  17. Kothary S, Rosenberg ZS, Poncinelli LL, Kwong S. Skeletal development of the glenoid and glenoid-coracoid interface in the pediatric population: MRI features. Skelet Radiol. 2014;43:1281–8.

    Article  Google Scholar 

  18. Kwong S, Kothary S, Poncinelli LL. Skeletal development of the proximal humerus in the pediatric population: MRI features. AJR Am J Roentgenol. 2014;202:418–25.

    Article  PubMed  Google Scholar 

  19. Laor T, Jaramillo D. MR imaging insights into skeletal maturation: what is normal? Radiology. 2009;250:28–38.

    Article  PubMed  Google Scholar 

  20. Lossos IS, Yossepowitch O, Kandel L, Yardeni D, Arber N. Septic arthritis of the glenohumeral joint. A report of 11 cases and review of the literature. Medicine (Baltimore). 1998;77:177–87.

    Article  CAS  Google Scholar 

  21. Malattia C, Rinaldi M, Martini A. The role of imaging in juvenile idiopathic arthritis. Expert Rev Clin Immunol. 2018;14:681–94.

    Article  CAS  PubMed  Google Scholar 

  22. Obembe OO, Gaskin CM, Taffoni MJ, Anderson MW. Little Leaguer’s shoulder (proximal humeral epiphysiolysis): MRI findings in four boys. Pediatr Radiol. 2007;37:885–9.

    Article  PubMed  Google Scholar 

  23. Ogden JA, Phillips SB. Radiology of postnatal skeletal development. VII. The scapula. Skelet Radiol. 1983;9:157–69.

    Article  CAS  Google Scholar 

  24. Ogden JA, Conlogue GJ, Jensen J. Radiology of postnatal skeletal development: the proximal humerus. Skelet Radiol. 1978;2:153–60.

    Article  Google Scholar 

  25. Ogden JA, Conlogue GJ, Bronson ML. Radiology of postnatal skeletal development. III. The clavicle. Skelet Radiol. 1979;4:196–203.

    Article  CAS  Google Scholar 

  26. Otjen J, Parnell SE, Menashe S, Thapa MM. Ultrasound-guided joint injections for MR arthrography in pediatric patients: how we do it. Pediatr Radiol. 2015;45:126.

    Google Scholar 

  27. Paz DA, Chang GH, Yetto JM Jr, Dwek JR, Chung CB. Upper extremity overuse injuries in pediatric athletes: clinical presentation, imaging findings, and treatment. Clin Imaging. 2015;39:954–64.

    Article  PubMed  Google Scholar 

  28. Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P. International league of associations for rheumatology. International league of associations for rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2.

    PubMed  Google Scholar 

  29. Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369:767–78.

    Article  CAS  PubMed  Google Scholar 

  30. Rockwood CA, Matsen FA. The shoulder. 4th ed. Philadelphia: Saunders/Elsevier; 2009. p. 12.

    Google Scholar 

  31. Roedl JB, Morrison WB, Ciccotti MG, Zoga AC. Acromial apophysiolysis: superior shoulder pain and acromial nonfusion in the young throwing athlete. Radiology. 2015;274:201–9.

    Article  PubMed  Google Scholar 

  32. Roth J, Jousse-Joulin S, Magni-Manzoni S, Rodriguez A, Tzaribachev N, Iagnocco A, Naredo E, D’Agostino MA, Collado P. Outcome measures in rheumatology ultrasound group. Definitions for the sonographic features of joints in healthy children. Arthritis Care Res. 2015;67:136–42.

    Article  Google Scholar 

  33. Roth J, Ravagnani V, Backhaus M, Balint P, Bruns A, Bruyn GA, et al. OMERACT ultrasound group. Preliminary definitions for the Sonographic features of synovitis in children. Arthritis Care Res (Hoboken). 2017;69:1217–23.

    Article  Google Scholar 

  34. Ruhoy MK, Tucker L, McCauley RG. Hypertrophic bursopathy of the subacromial-subdeltoid bursa in juvenile rheumatoid arthritis: sonographic appearance. Pediatr Radiol. 1996;26:353–5.

    Article  CAS  PubMed  Google Scholar 

  35. Trauzeddel R, Windschall D, Trauzeddel RF, Nirschl C, Ganser G, Palm-Beden K, Berendes R, Haller M, Krumrey-Langkammerer M, Nimtz-Talaska A, Schoof P, Lehmann H. Arthrosonographic reference values of the shoulder joint in healthy children and adolescents: a cross-sectional multicentre ultrasound study. Klin Padiatr. 2017;229:293–301.

    Article  PubMed  Google Scholar 

  36. Windschall D, Collado P, Vojinovic J, Magni-Manzoni S, Balint P, Bruyn GAW, Hernandez-Diaz C, Nieto JC, Ravagnani V, Tzaribachev N, Iagnocco A, D’Agostino MA, Naredo E. OMERACT paediatric ultrasound subtask force. Age-related vascularization and ossification of joints in children: an international pilot study to test multi-observer ultrasound reliability. Arthritis Care Res (Hoboken). 2017; https://doi.org/10.1002/acr.23335.

  37. Zember JS, Rosenberg ZS, Kwong S, Kothary SP, Bedoya MA. Normal skeletal maturation and imaging pitfalls in the pediatric shoulder. Radiographics. 2015;35:1108–22.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, Genoa, Italy

    Clara Malattia

  2. Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli studi di Genova, Genoa, Italy

    Clara Malattia

  3. Reumatologia Pediatrica, Clinica de Marchi, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Stefano Lanni

  4. Division of Radiology Ospedale Policlinico San Martino, Genoa, Italy

    Federico Zaottini & Carlo Martinoli

  5. Department of Health Science, University of Genova, Genoa, Italy

    Federico Zaottini & Carlo Martinoli

Authors
  1. Clara Malattia
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  2. Stefano Lanni
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  3. Federico Zaottini
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  4. Carlo Martinoli
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Correspondence to Clara Malattia .

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Editors and Affiliations

  1. Medway Foundation Trust, King’s College London, London, UK

    Yasser El Miedany

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Malattia, C., Lanni, S., Zaottini, F., Martinoli, C. (2020). Upper limb: Shoulder and Arm. In: El Miedany, Y. (eds) Pediatric Musculoskeletal Ultrasonography. Springer, Cham. https://doi.org/10.1007/978-3-030-17824-6_6

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  • DOI: https://doi.org/10.1007/978-3-030-17824-6_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-17823-9

  • Online ISBN: 978-3-030-17824-6

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