Keywords:
Paediatric, Musculoskeletal soft tissue, Musculoskeletal joint, Conventional radiography, Ultrasound, MR, Education, Trauma, Athletic injuries
Authors:
D. Howarth, K. A. Kingston; York/UK
DOI:
10.1594/essr2017/P-0231
Background
York Hospital catchment population is around 350 000 with 56 000 <16 years.
Musculoskeletal injuries are a common reason for imaging in all age groups but the pattern of injury and imaging approach will vary with patient age and skeletal maturity.
Plain films are often the initial imaging modality employed. In young children,
ultrasound is often used before MRI as the procedure is well tolerated,
quick and does not require sedation or GA which may be necessary to prevent movement artefact in MRI evaluation.
In adults the use of US or MRI for initial evaluation of injury will usually be decided with regard to the mechanism of injury,
the structures to be examined and whether dynamic assessment will be helpful.
CT is used sparingly in children to limit radiation exposure.
With increasing skeletal maturity the nature of injuries to the muscle-tendon-bone complex will change.
Acute and chronic traction apophyseal injuries can present across a range of commonly injured joints,
we will discuss the US and MRI appearances and the relative benefits of each modality.
Occasionally injury may involve only cartilaginous structures and be occult on plain film or extend to include the whole physeal plate and CT may need to be employed. In adolescents and young adults,
the injury is more likely to involve the myotendinous junction or occur along intermuscular planes,
both US and MR assessment may be of value.
Pure tendon injuries are rare in these age groups usually occurring in older adults once the tendons begin to degenerate.