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Updated: Nov 7, 2025
A Novel Application of Musculoskeletal Ultrasound Imaging
Published on: September 17, 2013
Musculoskeletal ultrasound assessment in pediatric knee hypermobility: a case control study
Laura R Ballenger1, Melissa Moore-Clingenpeel2, Edward J Oberle3
1Department of Rheumatology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. laura.ballenger@nationwidechildrens.org.
Insights
Musculoskeletal ultrasound (MSUS) revealed more abnormalities in knees with hypermobility and pain. Non-steroidal anti-inflammatory drug (NSAID) use was linked to increased synovial effusion in these patients.
Area of Science:
- Pediatric Rheumatology
- Musculoskeletal Ultrasound (MSUS)
- Joint Hypermobility Syndromes
Background:
- Musculoskeletal ultrasound (MSUS) is increasingly used in pediatric rheumatology.
- Literature often focuses on healthy children or juvenile idiopathic arthritis, with less on hypermobility mimicking arthritis.
- Chronic joint pain from hypermobility is a common pediatric rheumatology referral.
Purpose of the Study:
- To characterize knee MSUS findings in children with hypermobility and pain.
- To compare these findings against controls with hypermobility but no pain, and controls with neither condition.
Main Methods:
- A case-control study involving three groups: hypermobile with pain (H+P), hypermobile without pain (H-P), and no pain/hypermobility (NP).
- B-mode and Doppler MSUS imaging of the knee.
- Descriptive statistics and regression analysis for synovial effusion and hypertrophy scores.
Main Results:
- 91 knees from 50 participants were assessed.
- H+P knees showed significantly more positive MSUS findings (94%) compared to H-P (70%) and NP (74%) groups.
- Patellar tendon hyperemia was more prevalent in H+P knees (52%) versus controls (19-23%).
- NSAID use correlated with increased risk of synovial effusion (RR=1.83) and a trend towards higher effusion/hypertrophy scores.
Conclusions:
- Positive MSUS findings were common across all groups, but patellar tendon hyperemia was more frequent in those with knee hypermobility and pain.
- NSAID use was associated with increased synovial effusion.
- Further research should explore the link between tendon abnormalities, pain severity, and NSAID effects on MSUS.
Background:
While musculoskeletal ultrasound (MSUS) use in pediatric rheumatology is becoming more common, the majority of pediatric MSUS literature continues to focus on ultrasound findings in healthy children and juvenile idiopathic arthritis with little discussion of other musculoskeletal problems that may mimic arthritis such as joint hypermobility. Chronic joint pain related to hypermobility is a common referral to pediatric rheumatology clinics. Our aim is to describe the musculoskeletal ultrasound (MSUS) characteristics of the knee in a population with joint hypermobility and pain in comparison to control participants.
Methods:
Participants were recruited into three groups for a case-control study. Case group participants had knee hypermobility and pain symptoms (H + P). Participants in one control group had knee hypermobility without pain symptoms (H-P), and participants in the other control group had no knee hypermobility or pain symptoms (NP). B-mode and Doppler MSUS images were obtained and scored for each knee. Descriptive statistics are used for demographic variables and MSUS findings. Regression analysis is used to evaluate risk of synovial effusion and higher synovial effusion/hypertrophy quantitative score.
Results:
MSUS assessment was performed on 91 knees of 50 participants. H + P knees were more likely to have positive findings noted on MSUS (94% vs. 70% of H-P and 74% of NP knees, p = 0.043). Patellar tendon hyperemia was more common in H + P knees (52%, vs. 19% among H-P and 23% among NP, p = 0.025). Participants who reported taking scheduled non-steroidal anti-inflammatory drugs (NSAIDs) had an increased risk of synovial effusion (RR = 1.83, 95% CI = 1.07-2.30, p = 0.026) and a trend towards increased risk of a higher synovial effusion/hypertrophy quantitative score (RR = 1.77, 95% CI = 0.92-3.38, p = 0.086).
Conclusions:
While positive MSUS findings were frequent in all participants, patellar tendon hyperemia was more frequent in participants with knee hypermobility and pain symptoms. Additionally, reported use of NSAIDs was associated with an increased risk of synovial effusion and higher synovial effusion/hypertrophy quantitative score. Further study should assess correlation between tendon abnormalities and degree of pain symptoms as well as the effect of NSAIDs on MSUS findings.
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