title: Ultrasound investigation of the glenohumeral joint by anterior access in patients with rheumatoid arthritis and healthy controls.
abstract: BACKGROUND
  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.
  
  
  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.
authors.affiliation: Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Rozin
authors.affiliation: Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Kohava
authors.initials: K
authors.lastname: Toledano
authors.affiliation: Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Dagan
authors.affiliation: Department of Rheumatology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Balbir-Gurman
mesh_terms: D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D002356:Cartilage / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012785:Shoulder Joint / Q000000981:diagnostic imaging*; D018709:Statistics, Nonparametric; D013585:Synovitis / Q000000981:diagnostic imaging; D014463:Ultrasonography