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Final Program

1329 - Inter-Rater Reliability of Using Acromion-Greater Tuberosity Ultrasound Measurements in Children with Cerebral Palsy: A Pilot Study

Friday, February 28, 2025
5:00 PM - 6:30 PM MST

    Co-Author(s)

  • SD

    Sabrina S. Dieffenbach, MD

    Pediatric Rehabilitation Fellow
    Rutgers New Jersey Medical School
    Raritan, New Jersey, United States

    • Presenting Author(s)

  • DC

    Daniel Choi, BA

    Medical Student
    Hackensack Meridian School of Medicine
    Belle Mead, New Jersey, United States

    • Co-Author(s)

  • HS

    Hannah Shoval, MD

    Chair of Pediatric Rehabilitation Medicine
    Atlantic Health System
    Hillside, New Jersey, United States

Objectives: In children with cerebral palsy (CP), there are robust guidelines for hip surveillance to prevent hip dislocation. However, little attention is given to the shoulder, even though shoulder subluxation may lead to pain and debility.  In the adult stroke population, there are ultrasound based studies which evaluate glenohumeral subluxation with good validity and suggest that ultrasound is able to accurately  identify subluxation without the risk of radiation. One key measurement used is the distance between the lateral edge of the Acromion to the apex of the Greater Tuberosity, or Acromion-Greater Tuberosity Distance (AGT). To our knowledge, there has been no research on the validity of this measurement in children with CP. This study aimed to evaluate the feasibility and validity of AGT measurement with ultrasound in children.

Design: Ten pediatric CP patients (6 with quadriplegic CP, 4 with diplegic CP) were recruited from an outpatient Pediatric Rehabilitation Medicine clinic. Video ultrasound was used to measure the AGT. Two physiatrists independently measured the AGT.

Results:

A total of 18 shoulders were scanned (due to patient tolerance). The average AGT distance was 2.1 ± 0.4, with an inter-rater reliability of 88%. On average, the AGT distance of one side correlated with the other shoulder, with an average difference of 0.2 cm, and a correlation coefficient, R2  of 0.7. There was no association of AGT distance with gender, age, or the presence of spasticity.

Conclusions: This study showed good inter-rater reliability in AGT measurements in pediatric patients with CP, making it a promising tool to identify shoulders at risk for subluxation via serial, low cost imaging that avoids radiation.  Future studies with a larger number of subjects, including normal controls are needed to further validate this measurement and provide more insight into normal values in the pediatric population.