Related Experiment Video
Updated: Apr 16, 2026
A Novel Application of Musculoskeletal Ultrasound Imaging
Published on: September 17, 2013
Ultrasound of the joints and entheses in healthy children
Nancy A Chauvin1, Victor Ho-Fung, Diego Jaramillo
1Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA, chauvinn@email.chop.edu.
Insights
Ultrasound reveals normal tendon insertions in children, with thickness increasing with age. Tendon vascularity is common in younger children, and cartilage thickness varies by site and gender.
Area of Science:
- Pediatric Rheumatology
- Musculoskeletal Ultrasound
- Pediatric Orthopedics
Background:
- Tendon insertion pathologies like enthesitis and apophysitis in children can stem from trauma, overuse, or arthritis.
- Understanding the age-related ultrasound (US) appearance of normal pediatric joints is crucial for accurate pathology diagnosis.
Purpose of the Study:
- To document the age-related sonographic features of elbows, knees, and feet in healthy children.
- To establish a reference for the normal appearance of tendon insertions, apophyseal cartilage, and bursae in pediatric populations.
Main Methods:
- Prospective cross-sectional study involving 30 healthy children aged 4–18 years, divided into three age groups.
- Standardized joint examination by a pediatric rheumatologist, including pain and function questionnaires.
- Ultrasound evaluation of common extensor, common flexor, quadriceps, patellar, and Achilles tendons, plantar fascia insertions, and relevant bursae (anterior elbow, suprapatellar, retrocalcaneal).
Main Results:
- All 360 entheses appeared normal on grayscale ultrasound; tendon thickness showed a linear relationship with age.
- Tendon vascularity was observed in younger children (4–9 years), while mild peri-tendinous vascularity was noted in 10–13 year olds.
- Suprapatellar bursal fluid was detected in 15% of knees; boys had thicker apophyseal cartilage than girls at specific sites in the youngest group.
Conclusions:
- Tendon vascularity can be a normal finding in young children, with mild peri-tendinous vascularity acceptable in pre-adolescents.
- Tendon thickness increases linearly with age in children.
- Apophyseal cartilage thickness varies by anatomical site and gender.
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. Children were grouped according to age: group 1 (4-9 years, n = 11), group 2 (10-13 years, n = 9) and group 3 (14-18 years, n = 10). Children completed pain and function questionnaires and underwent a standardized joint examination by a pediatric rheumatologist. The common extensor, common flexor, quadriceps, patellar and Achilles tendons and plantar fascia insertions were evaluated with gray-scale and power Doppler ultrasound. The anterior elbow, suprapatellar and retrocalcaneal bursae were evaluated for fluid. We measured the apophyseal cartilage thickness at the enthesis. Correlation analyses examined associations between age and tendon thickness. We used ANOVA, with location as a repeated measure, to test for gender differences in cartilage thickness.
Results:
Children had a median age of 12.4 years and 55% were boys. All 360 entheses appeared normal on gray-scale imaging. There was a strong linear relationship between tendon thickness and age. Tendon vascularity was only present in young children (group 1), in 7/22 (32%) quadriceps tendons. Peri-tendinous power Doppler signal was seen at seven sites: two patellar, four quadriceps and one common flexor tendon, and all these children were in group 2. Suprapatellar bursal fluid <3 mm was detected in 9/60 (15%) knees. Of the children in group 1, boys had thicker apophyseal cartilage than girls at the medial epicondyle, patellar poles and os calcis (P < 0.05).
Conclusion:
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.
More Related Videos
Related Concept Videos
01:17Ultrasonography
During an ultrasonography procedure, a handheld device called...
01:20Ultrasound I: Abdominal Ultrasonography
Abdominal ultrasonography, commonly known as abdominal ultrasound, is a vital, non-invasive medical imaging technique widely used in healthcare.
Procedure:
This diagnostic tool allows the clinician to visually inspect internal structures within the abdomen, including vital organs such as the liver, gallbladder, pancreas, kidneys, and spleen.
The abdominal ultrasound process begins with applying a special gel to the patient's skin over the abdomen. This gel enhances the...
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:24Imaging Studies II: Ultrasonography
01:07Development of the Limb Synovial Joints
The mesenchymal stem cells differentiate into chondrocytes that form the hyaline cartilage, and later the cartilaginous model of the bone. This model further transforms into a bone. This process is known as endochondral ossification.
During development, the limbs...
01:25Assessment of the Abdomen I: Inspection and Auscultation
The abdominal examination is a cornerstone of clinical medicine, serving as a critical tool in diagnosing various gastrointestinal (GI) diseases. It involves a systematic approach that includes inspection and auscultation, each with distinct yet complementary roles in assessing the abdomen. This article will delve into these two primary methods healthcare professionals use to examine the abdomen.
Inspection of the Abdomen
The first step in any abdominal examination is inspection....