SonoKids MSK joints

Monoarthritis, defined as inflammation of a single joint, requires a thorough physical examination in children, as pain may be lacking in 10% to 30% of cases and joint stiffness may be the only symptom. Joint aspiration is a crucial diagnostic tool that remains markedly underused. Joint aspiration may be unnecessary, however, when the family history or other investigations provide the diagnosis. Radiographs of the involved joint may supply information on the severity of the lesions. In doubtful cases and in patients with arthralgia, B-mode and Doppler ultrasound or magnetic resonance imaging (MRI) may confirm the presence of synovitis...

OBJECTIVE: The aim of this study was to determine whether elbow ultrasound findings of the posterior fat pad (PFP) are present in patients with diagnosis of radial head subluxation (RHS). METHODS: This was a prospective study of children presenting to an urban pediatric emergency department diagnosed clinically with RHS. Physicians received a 1-hour training session on musculoskeletal ultrasound including the elbow. Before performing reduction for RHS, the physicians performed a brief, point-of-care elbow ultrasound using a high-frequency linear transducer probe in both longitudinal and transverse views to evaluate for PFP elevation and lipohemarthrosis (LH)...

BACKGROUND: Tendon insertion pathologies such as enthesitis and apophysitis in children can result from trauma, overuse syndrome and arthritis. Knowledge of the US appearance of normal joints by age might aid diagnosis of pathologies. OBJECTIVE: We describe the age-related sonographic features of the elbows, knees and feet in healthy children, providing a reference for the normal appearance of tendon insertions, apophyseal cartilage and bursae. MATERIALS AND METHODS: This is a prospective cross-sectional study of 30 healthy children...

In the assessment of septic arthritis of the hip in a pediatric population, ultrasound is a safe and easily conducted method to confirm an effusion. The need for MRI to further evaluate the patient for adjacent infection before treatment is debatable. Once an effusion is confirmed on ultrasonography, we have found that septic arthritis of the hip does not need advanced imaging before arthrotomy and debridement. Patients who fail to clinically respond to an initial hip arthrotomy and appropriate antibiotics may benefit from an MRI for the identification of concomitant infections that may require surgical intervention...

Children presenting with hip pain or a limp are a diagnostic challenge for the clinician. The differential diagnosis is extensive, and the workup can be broad. This review focuses on differentiating between transient synovitis and septic arthritis of the hip. The role of bedside ultrasound in the clinical evaluation of these patients is addressed, including the technique and appropriate indications for bedside ultrasound of the hip in the emergency department.

Point-of-care ultrasound has become a useful clinical adjunct, especially in emergency medicine, because it is noninvasive, repeatable, and nonradiating. In cases of pulled elbow also known as nursemaid's elbow or radial head subluxation, diagnosis is usually performed clinically. However, there is the potential for a failed reduction or misdiagnosis. We introduce a potentially useful diagnostic finding for pulled elbow ("Hook sign") using point-of-care ultrasound in the emergency department.

BACKGROUND: This study was conducted to evaluate the current status of pediatric hip sonography at German university hospitals. MATERIAL AND METHODS: A questionnaire was sent to all heads of orthopedic departments in Germany. They were asked to give details of the technique and instrumentation used for hip ultrasound examination, local organization of consultation and options for advanced training of students and staff. RESULTS: The return rate of the questionnaires was 93...

BACKGROUND: Loss of joint cartilage is a feature of destructive disease in JIA. The cartilage of most joints can be visualized with ultrasonography (US). Our present study focuses on discriminant validity of US in children. We studied reproducibility between and within a skilled and a non-skilled investigator of US assessment of cartilage thickness in small and large joints in healthy children. METHODS AND RESULTS: In 11 healthy children (5 girls/6 boys), aged 9...

Children with complaints of hip pain, a painful limp, or refusal to weight bear commonly present to the Emergency Department (ED). The ability to use point-of-care ultrasound in the ED to diagnose a hip joint effusion and to guide arthrocentesis can be helpful to facilitate diagnosis and management of these children. The capsular-synovial thickness of the hip is measured from the anterior bony cortical surface to the posterior surface of the iliopsoas muscle at the concavity of the femoral neck. A capsular-synovial thickness>5 mm, or >2 mm difference compared to the asymptomatic contralateral hip are the described sonographic criteria for hip joint effusion in children...

We present a case of a 3-year-old girl brought to the emergency department for evaluation of limp after falling off the monkey bars 1 day prior. X-rays of the entire left lower extremity were normal with no evidence of fracture, dislocation, or effusion. Point-of-care ultrasound of the left hip demonstrated a hip effusion, which prompted further imaging, ultimately revealing an occult fracture of the left proximal femoral metaphysis. This case demonstrates the ability of point-of-care ultrasound to guide the management of patients presenting to the pediatric emergency department with musculoskeletal complaints...