Musculoskeletal ultrasound in children: Current state and future directions

Abstract

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of chronic inflammatory arthritides that if inadequately treated, may be associated with chronic disability and deformity. Early diagnosis and treatment initiation is essential in the management of patients with JIA. Conventional means of evaluation of disease presence, disease activity and response to therapy including physical exam, labs and x-rays are at times limited and may be insufficient in making an accurate assessment. Musculoskeletal ultrasound (MSUS) is a well-established modality that is patient and family-friendly, non-invasive, does not require sedation and can be performed at the bedside in real-time. MSUS offers information that cannot be attained by standard outcome measures, and may help to advance both diagnosis and treatment of patients with JIA ultimately improving patient outcomes. This review explores the background of MSUS and the current evidence to support its potential role as a diagnostic, disease activity monitoring and interventional tool.

Figure 1

A longitudinal view of the suprapatellar knee joint with evidence for a large effusion and synovial hypertrophy.

Figure 2

Power Doppler (PD) image of a radiocarpal wrist joint with evidence for active synovitis demonstrating large effusion, synovial hypertrophy and PD signal.

Figure 3. a, b

Transverse image of a tendon sheath injection (a); Visualization of steroid as it is injected into the tendon sheath (b).