Accuracy of Ultrasound in Determining Proximal Humeral Epiphyseal Widening in Youth Athletes: A Case Series

Abstract

Exposing children to numerous radiographs in order to diagnose various musculoskeletal injuries is not ideal due to the deleterious side effects of ionizing radiation on growth plates. In particular, Little Leaguer’s Shoulder is a common pediatric and adolescent injury that relies mainly on radiographs in order to recognize and treat. Thus, if other imaging modalities without ionizing radiation, such as ultrasound, can be shown to be reliable and accurate in measuring humeral physeal width, it may serve as a better means of identifying these injuries. The purpose of this study was to assess the consistency of two separate physician measures of proximal humeral epiphysis widening in children ages 12-16. Inter-rater and intra-rater reliability of ultrasound measurements of the proximal humeral epiphysis was calculated among twelve patients with open physes. Longitudinal measurements of the epiphyseal plate were obtained in three locations: just distal to the most lateral aspect of the acromion, 2 cm anterior to that line, and 2 cm posterior to that line with the same measurements repeated on the opposite arm. Measurements were then averaged for an overall width. Overall, no statistically significant variation was found when comparing epiphyseal plate width on dominant versus non-dominant arms. Ultrasonographic measurement of proximal humeral epiphyseal width shows narrow variability when used and interpreted by a sports medicine physician.