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Imaging of Pediatric Disorders of the Shoulder

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The Shoulder

Abstract

During childhood, the structures of the shoulder become progressively ossified. Their contour, however, is similar to the ossified structures of the adult. There are physis at the chondro-osseous junction of the glenoid and the base of the coracoid which can be confused with injuries. The acromion ossifies in an oblique fashion and there is never a coronal oriented physis joining the posterior to the anterior acromion. The humeral epiphysis has multiple ossification centers that become fatty during the first year of life. The physis of the proximal humerus has a uniform thickness and is separated from the rest of the bone by a well-defined zone of provisional calcification.

Dysplasia of the glenoid is primarily seen as a sequela of brachial plexus injury. The humeral head subluxes posteriorly and the glenoid loses its posterior concavity. There is marked atrophy of several of the muscles. Ultrasound and later MRI are important to define the displacement of the humeral head and the glenoid version.

Infections occur primarily in the metaphysis of the proximal humerus. Trauma can affect the physis in unique ways. In the neonatal period, birth-related trauma can result in epiphyseal separation. In the adolescent, particularly in baseball players, the physis can become wide and irregular with partial loss of the zone of provisional calcification. The proximal humeral epiphysis is one of the most common sites of chondroblastoma. Osteochondromas can occur along the physes of the scapula. The metaphysis of the humerus is one of the common sites for osteosarcoma and Ewing sarcoma.

Familiarity with the normal pattern of ossification and marrow transformation is fundamental for the understanding of childhood diseases affecting the scapula.

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Author information

Authors and Affiliations

  1. Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

    Jorge Delgado

  2. Department of Radiology, Columbia University Medical Center, New York, NY, USA

    Diego Jaramillo

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  1. Jorge Delgado
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  2. Diego Jaramillo
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Editors and Affiliations

  1. Penn Medicine Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Jenny T. Bencardino

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Delgado, J., Jaramillo, D. (2019). Imaging of Pediatric Disorders of the Shoulder. In: Bencardino, J. (eds) The Shoulder. Springer, Cham. https://doi.org/10.1007/978-3-030-06240-8_13

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  • DOI: https://doi.org/10.1007/978-3-030-06240-8_13

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