Ultrasound Investigation of the Glenohumeral Joint by Anterior Access in Patients with Rheumatoid Arthritis and Healthy Controls
Alexander P. Rozin, Kohava Toledano, Amir Dagan, Alexandra Balbir-Gurman
Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel
Med Sci Monit 2015; 21:533-541
Available online: 2015-02-18
The aim of this study was to measure glenohumeral joint (GHJ) parameters via the anterior access through ultrasound and to compare to data from posterior and inferior accesses.
Material and Methods: Twenty healthy controls (M: F=15: 5, aged 45.1±11.2 years) and 16 patients (M: F=5: 11, aged 54.6±14.7 years) with active rheumatoid arthritis (RA) (DAS 28 4.6±1.2) were investigated (SonoSite-Titan). To make the GHJ visible on the anterior access, we used the original GHJ opening maneuver. The GHJ width was measured for every transducer position at 2 points. The positions were: posterior transversal, inferior longitudinal, anterior longitudinal along the articular line, anterior transversal upper, middle and lower. The joint width included thickness of cartilage plus synovial fluid/pannus. Rotator interval (RI) width and height (upper biceps channel) were measured.
Results: Our normal GHJ values by posterior and inferior accesses were within previously estimated values (<2 mm and <3 mm, respectively). We acquired the first values of GHJ width from the anterior access. The last were within a range of 0.7–1.7 mm for healthy controls. Patients with RA showed significantly enlarged joint cavities. RI was not inflamed. Posterior and inferior data of GHJ width were significantly correlated (p=0.01). The data did not correlate with anterior values (p=+0.44, p=–0.56). Synovitis was much more prominent in posterior, upper anterior transversal, and anterior longitudinal accesses.
Conclusions: The GHJ may be visualized by anterior access using a special maneuver. Synovitis in the anterior region of the GHJ may develop at an independent rate. Anterior GHJ sonography may be complementary to the classic access.
Keywords: Arthritis, Rheumatoid - ultrasonography, Cartilage - ultrasonography, Case-Control Studies, Demography, Shoulder Joint - ultrasonography, Statistics, Nonparametric, Synovitis - ultrasonography