Background/Purpose: Ultrasound is an established tool to detect changes of joints, tendons and entheses in rheumatology. However, several studies detected structural and vascular changes in tendons and entheses as well as joint effusion in athletes and physical active individuals (1–3). This evidence may raise the question, whether a patient’s ultrasound findings are related to a rheumatic disease or associated with sports activities. The purpose of this study was to evaluate the development of joint effusion, hyperperfusion and enthesitis in large and medium joints of young healthy individuals after one hour of supervised weight training.

Methods: We applied ultrasound to examine the shoulder, elbow, wrist, hip, knee, and ankle joints, as well as associated entheseal sites such as the Achilles tendon and the plantar aponeurosis, in healthy individuals under the age of 30. The ultrasound examination was carried out before, 24h after and 48h after the participants conducted one hour of supervised weight training. Friedman test was applied to determine significant changes of the prevalence of joint effusion and enthesitis within 48h after the physical activity. Bonferroni-corrected p-values are shown for post-hoc tests.

Results: Fifty-one healthy individuals with a mean age of 23.7 years (19;30 ± 2.46) were included, 52.9% were female with a mean BMI of 22.5 kg/m2 (18.6;36.6 ± 3.07). The percentage of individuals with joint effusion in at least one joint increased from 72.55% (n=37) at baseline to 88.24% (n=45) after 24h and to 94.12% (n=48) 48h after the training. The mean number of joints affected by effusion were 1.49 at baseline, 2.82 after 24h and 4.16 after 48h.

Fourteen participants (27.45%) presented with entheseal pathology in at least one enthesis at baseline, 47.06% (n=24) showed pathologies after 24h and in 56.86% (n=29) entheseal pathology was observed 48h after the weight training. The only entheseal pathology observed 24h and 48h after the training was hyperperfusion.

The Friedman test and post-hoc tests revealed a significant increase in joints with effusion within 48 hours of weight training (Q=-1.255, p< 0.0001). Results also showed a significant increase of detected entheseal pathology from baseline to 48h after the weight training (Q= -0.588, p=0.009).

Conclusion: Prevalence of joint effusion in large and medium joints as well as the prevalence of entheseal pathology increase significantly within 48h after weight training. Therefore, the patient’s sports activities should be taken into account when performing a musculoskeletal ultrasound examination.

1. Gisslen K, Gyulai C, Nordstrom P, Alfredson H. Normal clinical and ultrasound findings indicate a low risk to sustain jumper’s knee patellar tendinopathy: a longitudinal study on Swedish elite junior volleyball players. Br J Sports Med. 2007 Feb 20;41(4):253–8.
2. Méric J-C, Grandgeorge Y, Lotito G, Pham T. Walking Before an Ultrasound Assessment Increases the Enthesis Score Significantly. J Rheumatol. 2011 May;38(5):961–961.
3. Lohman M, Kivisaari A, Vehmas T, Kallio P, Malmivaara A, Kivisaari L. MRI abnormalities of foot and ankle in asymptomatic, physically active individuals. Skeletal Radiol. 2001 Mar 5;30(2):61–6.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/development-of-joint-effusion-hyperperfusion-and-enthesitis-after-one-hour-of-age-and-gender-adjusted-weight-training/