These studies again show that the knowledge of the normal gleno-humeral relationship is important. To evaluate this method of measuring retroversion, the protocol was tested in patients before and after shoulder arthroplasty. beware not to injure when plating proximal humerus fractures Retroversion was measured according to two proximal axes and one distal axis (transepicondylar axis). doi: 10.2106/JBJS.L.00856. - if posterior glenoid bone loss is present, consider altering amount of humeral retroversion from the normal 35 deg to a less retroverted position; - attempt to recreate the normal humeral … When correlating age with decrease of retroversion, the Spearman Rho test was performed for retroversion measurement and Narakas’ score and passive external rotation, no significant correlations were found (P > 0.05). Humeral head retroversion is not well described with the literature controversial regarding accuracy of measurement methods and ranges of normal values. The mean humeral retroversion of the affected shoulder was significantly increased compared with the normal contralateral side (-28.4 +/- 12.5 degrees v -21.5 +/- 15.1 degrees, p = 0.02). One well-studied exception is the throwing athlete, for whom retroversion has been shown to be greater on the dominant throwing side, due to repetitive throwing that usually begins in early childhood[17-21]. Nonetheless, the reduction in muscle ratio does not support the theory that the internal rotators overpower the injured (paralyzed) external rotators, but suggests that failure of the SSc to grow or develop may result in a contracted SSc, which restricts external rotation. if position of glenoid retroversion is required, then the humeral stem should be less retroverted to avoid posterior dislocation; avoid valgus positioning of humeral stem This is a commonly used axis in various retroversion studies[19,28-32]. This position is directly related to the humeral version angle. Correlation analyses were also performed in the values of version between dominant and nondominant shoulders and between humeral head version and glenoid version. Cross-sectional areas of the IS and SSc muscles were measured using the closed region-of-interest polygon tool in Osirix (Pixmeo). Shoulder Elbow. SSc and IS muscle size on the involved side was significantly decreased, 2.26 cm² vs 2.79 cm² and 1.53 cm² vs 2.19 cm², respectively (P < 0.05). We hypothesized that the retroversion angle (RV-angle) on the involved side would be significantly decreased relative to the uninvolved side and that the difference would increase with age. Online ahead of print. This study was conducted to compare the concordance and reliability between the standard method and 5 other measurement methods on two-dimensional (2D) computed tomography (CT) scans.CT scans from 21 patients who underwent shoulder arthroplasty (19 women and 2 men; mean … Another explanation for the increased external rotation can be possibly attributed to increased humeral retroversion which is a common finding in players playing overhead sports (31-33). 2017 Jul;26(7):1128-1136. doi: 10.1016/j.jse.2017.01.027. These surgical interventions all aim for better function through an improved position of the hand in space. The existing common treatment options all strive for better function of the upper extremity through an improved position of the hand in space. The TIFF files were imported into Geometer’s Sketchpad version 5.03 (KCP Technologies, Emeryville, CA, United States) for further retroversion analyses. Both humeral head retroversion and glenoid retroversion were significantly higher on the dominant side than on the nondominant side and significantly higher in men than in women. This study found differences in humeral head version and glenoid version by sex and shoulder dominance in a large sample. Values of humeral head and glenoid version were measured. Our Radiology department anonymized the MRI studies before performing our measurement protocol; Digital Imaging and Communications in Medicine files were imported as a numerical database into Osirix (Pixmeo, Geneva, Switzerland). A computer tomography morphometric study. Since the subscapularis (SSc) and infraspinatus (IS) muscles, are an agonist-antagonist muscle pair regarding humeral rotation, we hypothesized that an imbalance between these muscles would correlate with altered humeral version. Normal and pathologic glenohumeral morphology in the growing shoulder: Pitfalls in clinical assessment of shoulder pathology, ... keywords = "Humeral retroversion, Neonatal Brachial Plexus Palsy, retroversion, CT, MR, glenoid, humerus, shoulder", author = "{van de Bunt}, F.", The 35 children included in our study had a mean age of 4.3 mo (range of 2.1-6.5 mo), and they were classified according to the Narakas classification: Narakas I: 18 cases; Narakas II: 4 cases; Narakas III: 15 cases. Figure 3 shows the distribution of measurements. In two patients, retroversion increased on the involved side (Table 1). Humeral retroversion and shoulder muscle changes in infants with internal rotation contractures following brachial plexus birth palsy. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. In this scenario the amount of humeral retroversion is 15 degrees. Bilateral magnetic resonance imaging (MRI) scans of 35 infants (age range: 2-7 mo old) with BPBI were retrospectively analyzed. All children were given pethidine, droperidol and chlorpromazine intramuscularly. Perhaps these methodological differences explain these contradictory findings. We measured these changes in infants 2-7 mo old and found that altered humeral development can occur very early in life in a population where internal rotation contractures are apparent. The ischial spine sign is also a marker of retroversion, which occurs when the ischial spine projects into the pelvis on an AP view (Fig. Average glenoid retroversion was 1° ± 3°, ranging from -9° to 13°. This study has several limitations. CT scan methods accurately measure humeral head retroversion, while radiographic methods do not. 2016 Mar;25(3):493-501. doi: 10.1016/j.jse.2015.08.003. Methods: Three-dimensional models of the full-length humerus were generated from computed tomography data for the Walch type B group (n = 59)and for a control group of normal nonarthritic shoulders (n = 59). However, this has not yet been related to altered humeral version. The mean difference in retroversion correlated significantly by Pearson's product moment with the difference in external (P = 0.001) and internal (P = 0.003) rotation measurements. Humeral head retroversion and shoulder rotation in both the frontal and scapular plane were studied in 34 patients with anterior glenohumeral instability. The most common musculoskeletal sequela of neurologic injury of brachial plexus birth palsy (BPBI) is an internal rotation contracture of the shoulder. The first proximal reference axis was chosen to provide continuity with earlier retroversion analysis performed in this specific patient group[10,11]. They studied this relationship as correlations between lines at the humeral and at … A line segment was created, which spanned the greatest distance from the periphery of the greater tuberosity to the medial articular surface and is labeled as the skew axis (SA) (Figure 1)[2]. retroversion angle, based on the axial rotation of the humeral head in an axial transverse plane, is measured as the angle between the axes of the humeral diaphysis and the humeral … NIH  |  A prospective study analyzing changes in humeral version over time would be of interest to assess the predictive value of decreased retroversion at such a young age, concerning various treatment options (soft-tissue and bony).  |  However, the SA yielded systematically higher values in the deformed humeral head compared to the HCL. HCL: Humeral center line; RV-angle: Retroversion angle. We measured humeral version relative to two proximal axes and one distal axis (transepicondylar axis). The distribution analysis showed an approximately normal distribution. Pearson product-moment or Spearman rank correlation coefficients are estimated between each of these and passive external rotation and Narakas classification, as appropriate, based on the underlying distribution and type of the data. Twenty-two patients had traumatic anterior shoulder dislocations and another 12 patients had … Keywords: Our main goal was to further elucidate the timing that these anatomic changes may occur; therefore, we included our youngest patient population. This increase was found only in the children over the age of 12 months. MRI studies were performed on a 1.5-T MRI-unit (Magnetom 1.5 T Vision; Siemens, Erlangen, Germany). Methods: A large reduction in humeral retroversion at a very young age could be a predictor (or an argument when apparent at an older age) for the necessity of a humeral derotational osteotomy to provide adequate improvement of hand and possibly elbow function. Particular attention was focused on humeral head retroversion, shoulder stability, and range of motion in relation to surgical technique. NLM Inter-rater reliability assessment by Intraclass correlations coefficient (ICC) was performed. Humeral retroversion isn’t necessarily a bad thing. Our results suggest that declined humeral version is not something these children slowly grow into. © 2004-2021 Baishideng Publishing Group Inc. All rights reserved. Normal humeral retroversion is greatest at birth and gradually decreases through adolescence [13-15] to adult values averaging between 25-30 with well documented individual variation . 3). There was no difference between genders. Passive external rotation was measured with the arm in the adducted position and the elbow by the side. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. The ICC for interrater reliability on the uninvolved side was 0.923 (95%CI: 0.853-0.960; P < 0.001). We found a significant reduction of humeral retroversion on the involved side compared to the uninvolved side in a consecutive series of patients with internal rotation contractures secondary to BPBI. Shoulder morphology; glenoid morphology; glenoid retroversion; humeral head retroversion; humeral torsion; humerus morphology; shoulder arthroplasty. Core tip: This study examines humeral retroversion in infants who sustained neonatal brachial plexus palsy and suffered from an internal rotation contracture. For humeral version measurements, axial plane slides from the involved and uninvolved side that to our best efforts represented the midpoint of the humeral head were selected. Analyses of the IS and SSc muscles are based on cross-sectional area measurements from the MRI-slice, depicting the largest muscle belly as used in multiple previous studies[6,35,36]. has been reported.8 Implanting the humeral stem in less retroversion has long been believed to add stabili-ty, but was recently found to have little biomechanical benefit.10,11 Recently, a novel “anterior offsetting” technique of the humeral head component has been proposed. Glenoid version was found to be 1.5° of retroversion in men and 0.9° of retroversion in women.  |  the lateral humeral offset to optimize the moment arm of the deltoid muscle and the rotator cuff. Paired differences averaged 17.5°, with a range from -22.2° to 53.3°. van de Bunt F, Pearl ML, van Essen T, van der Sluijs JA. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. The HCL represents the perpendicular projection from the margins of the articular surface. Additionally, the size of the SSc and IS muscles on the involved side was significantly decreased, as was the muscle ratio (SSc/IS) on the involved side compared to the uninvolved side. Age did not correlate with a decrease in humeral retroversion (r = -0.108, P = 0.538). A Bland-Altman plot was created to visualize potential differences in retroversion measuring methods[33]. 2018 Jan;27(1):181-188. doi: 10.1016/j.jse.2017.08.014. The glenoid and humeral head in shoulder osteoarthritis: A comprehensive review. Of further note, the earliest reports by Scaglietti[11] and van der Sluijs et al[10] found an increase in retroversion. Pearson’s product correlation tests were performed for the retroversion measurements, the ΔRV-angle and the muscle area ratios and muscle surface area measurements, however no significant correlations were found on the involved side. Retroversion of the humeral head and the range of motion of the shoulder joint in both the frontal and the scapular plane have been studied in 100 shoulder joints in 50 healthy subjects, 25 men and 25 women. 12). We studied humeral retroversion in 35 consecutive infants who were under evaluation for treatment of their internal rotation contractures secondary to unilateral BPBI in this retrospective observational study. Age was again not correlated with a decrease in humeral retroversion (r = -0.120, P = 0.492). Epub 2017 Jun 6. However, the mean age of the study groups differed considerably, 3.2 years old vs 4.3 mo old. Humeral retroversion measured 36.6° ± 9.8° in the dominant and 26° ± 9.4° in the nondominant extremity. eCollection 2018 Dec 18. Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). The average humeral head retroversion was 26° ± 11°. Consistent with the literature, we observed a significant decrease in muscle size on the involved side compared to the uninvolved side, with the SSc muscle being more affected than the IS muscle[6,34-36]. Both the humeral head and glenoid are thought to be more retroverted in high-demand shoulders. Further research is necessary to elucidate a causal relationship between those mechanisms and shoulder deformities, concerning both the humerus and glenoid, which will help guide clinical treatment decisions for BPBI. We measured retroversion in 65 cadaveric humeri, including 52 paired specimens, using four methods: radiographic, computed tomography (CT) … Furthermore, the muscle ratio (SSc/IS) on the involved side was significantly smaller compared to the uninvolved side (P = 0.007). Internal rotation contractures varied from -45° to 12°, with a mean of -18°, measured as passive external rotation with the elbow by the side (Table 1). COVID-19 is an emerging, rapidly evolving situation. Epub 2015 Oct 23. Previous studies presented opposite findings, as both older studies reported an increased humeral version angle[10,11], while more recent studies reported a decrease in humeral retroversion[9,12]. • Little Leaguer’s shoulder, which is rotational stress fracture of the proximal humeral epiphyseal plate, may change humeral retroversion. Normal Humeral Head Retroversion Angle in Korean Measured with Semil - axial View Jung Ho Park, Jong Keon Oh, Kwang Suk Lee, In Jung Chae, Seung Beom Han and Jeong Ro Yoon: Go to: ... Humeral head retroversion angle was determined from 80 healthy subjects, 48 men and 32 women. USA.gov. The 95% two-tail confidence interval for humeral head retroversion was 30 degrees-35 degrees for the dominant side and 26 degrees-31 degrees for the nondominant side. 2018 Dec 18;9(12):292-299. doi: 10.5312/wjo.v9.i12.292. J Shoulder Elbow Surg. Anatomical shoulder arthroplasty for osteoarthritis has shown consistent and good results in shoulder with a rotator cuff-intact glenohumeral joint. These bony deformities have been thought to be a consequence of abnormal muscular development[6-8]. With greater retroversion of the humerus, there is the potential for more external rotation. Scapular resting position and gleno-humeral movement dysfunction in asymptomatic racquet players: a case-control study This site needs JavaScript to work properly. The measurements made were based on axial slices of the humerus; measurements made from a 3D-reconstruction, as those performed by Sheehan and others, would have the potential for minimizing errors related to patient positioning and inconsistent image acquisition. Clipboard, Search History, and several other advanced features are temporarily unavailable. Humeral stem fixation cemented stem or uncemented porous-coated implants ; position of humeral stem should be 25-45° of retroversion . 2018 Jul;10(3):192-200. doi: 10.1177/1758573217711897. Therefore, a thorough understanding of the development of the pathogenesis of this injury is important. This contracture is frequently associated with deformity of the glenohumeral joint[1-5]. West EA, Knowles NK, Athwal GS, Ferreira LM. In glenoid version measurement, 3-dimensionally corrected slices were reconstructed to eliminate scapular inclination. Is global humeral head offset related to intramedullary canal width? In our studied age group, the humeral head and epicondylar axis are mostly cartilaginous, making 3D-reconstruction of the humeral anatomy much more challenging than in a skeletally mature subject. The blue and orange dotted lines represent the 95% limits of agreement. 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Spss Inc., Chicago, IL, United States ) changes in the glenoid Based... For humeral head retroversion was correlated with a range from -22.2° to 53.3° large! This scenario the amount of humeral retroversion that the knowledge of the humeral center line RV-angle. Humeral offset to optimize the moment arm of the glenoid hull method for analyzing humeral subluxation in primary glenohumeral.! Significant effect on humeral version relative to the humeral head the results of the hand in space currently,! The potential for more external rotation measurements, Günaydın B, Çetin MÜ, Özçaglayan Ö Bilsel.

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