NLM They studied this relationship as correlations between lines at the humeral and at … 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. Standard descriptive measures as mean, standard deviation, minimum and maximum values are reported for retroversion of the involved and uninvolved sides, as for the muscle surface area measurements, and their difference (Δ) within the study population. Bouacida S, Gauci MO, Coulet B, Lazerges C, Cyteval C, Boileau P, Chammas M. J Shoulder Elbow Surg. Background: A trend (b P = .058) toward greater humeral retroversion was also observed in the nondominant arm of Latin American compared with North American pitchers. 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]. All children were given pethidine, droperidol and chlorpromazine intramuscularly. In conclusion, humeral retroversion has a high likelihood of being significantly decreased in this patient population. 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. The HCL represents the perpendicular projection from the margins of the articular surface. 2018 Jul;10(3):192-200. doi: 10.1177/1758573217711897. The purpose of this study was to evaluate the normal values of humeral head version and glenoid version on computed tomography scans and to clarify their features in the normal glenohumeral joint. Furthermore, this study shows that secondary osseous changes can occur within several months in this patient population. Coxa profunda (Fig. doi: 10.2106/JBJS.L.00856. Retroversion on the involved side was significantly decreased, 1.0° vs 27.6° (1) and 8.5° vs 27.2° (2), (P < 0.01), as compared to the uninvolved side. This increase was found only in the children over the age of 12 months. The size of the SSc and IS muscles 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). 2018 Dec 18;9(12):292-299. doi: 10.5312/wjo.v9.i12.292. The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26° ± 11°. This contracture is frequently associated with deformity of the glenohumeral joint[1-5]. 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. Furthermore, the muscle ratio (SSc/IS) at the involved side was significantly smaller compared to the uninvolved side (P = 0.007). Our objective was to elucidate the timing that decreased retroversion may occur; therefore, we included our youngest patient population (2-7 mo old). Both measurement methods yielded comparable results in the uninvolved shoulder. - 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 … Another theory could be that the changes in humeral retroversion are partially related to injured muscles outside of the rotator cuff, perhaps those with at least some innervation outside of the original zone of injury. For retroversion measured by HCL, the ICC for interrater reliability on the involved side was 0.934 (95%CI: 0.863-0.967; P < 0.001). It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. In two patients, retroversion increased on the involved side (Table 1). Twenty-two patients had traumatic anterior shoulder dislocations and another 12 patients had … 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. However, this has not yet been related to altered humeral version. Published by Elsevier Inc. All rights reserved. Epub 2015 Oct 23. 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. Normal and pathologic glenohumeral morphology in the growing shoulder: Pitfalls in clinical assessment of shoulder pathology, from physical examination to imaging techniques F. van de Bunt Research output : PhD Thesis › PhD Thesis - Research VU, graduation VU Based on the literature, retroversion of the humeral head is shown as a positive value and anteversion is shown as a negative value. 2018 Sep 12;5(1):35. doi: 10.1186/s40634-018-0148-2. These surgical interventions all aim for better function through an improved position of the hand in space. The existing common treatment options for children suffering from brachial plexus birth palsy all strive for better function of the upper extremity through an improved position of the hand in space. Age was again not correlated with a decrease in humeral retroversion (r = -0.120, P = 0.492). The distribution of measurements was larger on the involved side (Figure 4). 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. No correlation was found between humeral head version and glenoid version. In five patients, retroversion was increased on the involved side (Table 1). 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. Type A has concentric wear and no subluxation of the humeral head. 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. The fulcrum axis: an accurate measure of glenoid version on radiographs and computed tomography. A FISP three-dimensional pulse acquisition sequence (repetition time, 25 msec; time to echo, 10 msec; flip angle 40°) with ranges from 0.8 to 1.5 mm partitions was used to obtain images from both shoulders and upper arms, representing the full humerus and glenohumeral joint in the axial plane. Interest in the glenoid hull method for analyzing humeral subluxation in primary glenohumeral osteoarthritis. Humeral head retroversion is not well described with the literature controversial regarding accuracy of measurement methods and ranges of normal values. USA.gov. In Table 2, the results of the muscle cross-sectional area measurements are summarized. Scaglietti’s study was in a very different era of imaging technology and presented his observations with little quantitative data. The retroversion angle This position is directly related to the humeral version angle. We measured humeral version relative to two proximal axes and one distal axis (transepicondylar axis). Particular attention was focused on humeral head retroversion, shoulder stability, and range of motion in relation to surgical technique. The distribution analysis showed an approximately normal distribution. The center of rotation of the normal humeral head is, on Furthermore, the ratio of the SSc and IS muscle (SSc/IS) was calculated to compare muscle balance between both sides and correlate these with the ΔRV-angle. Age did not correlate with a decrease in humeral retroversion (r = -0.108, P = 0.538). National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. World J Orthop. Images for analysis were computed tomography scans of 410 normal shoulders from healthy volunteers. Furthermore, muscle thickness was only assessed for the IS and SSc muscles, and the measurement of other external and internal rotator muscles may offer additional insight into muscle behavior and its effect on humeral retroversion in this population. We measured retroversion in 65 cadaveric humeri, including 52 paired specimens, using four methods: radiographic, computed tomography (CT) … The Narakas classifications were assigned as described by Narakas[27]. The most common musculoskeletal sequela of neurologic injury of brachial plexus birth palsy (BPBI) is an internal rotation contracture of the shoulder. Humeral retroversion and shoulder muscle changes in infants with internal rotation contractures following brachial plexus birth palsy. Posterior glenoid bone grafting in total shoulder arthroplasty for osteoarthritis with severe posterior glenoid wear While glenoid retroversion and posterior humeral head decentering are common preoperative features of severely arthritic glenohumeral joints, the relationship of postoperative glenoid component retroversion to the clinical results of total shoulder arthroplasty (TSA) is unclear. Retroversion on the involved side was significantly decreased, 1.0° vs 27.6° (1) and 8.5° vs 27.2° (2), (P < 0.01), as compared to the uninvolved side. 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). Of further note, the earliest reports by Scaglietti[11] and van der Sluijs et al[10] found an increase in retroversion. Glenoid version was found to be 1.5° of retroversion in men and 0.9° of retroversion in women. Normal depth is defined as acetabular fossa lateral to the ilioischial line. Would you like email updates of new search results? Is global humeral head offset related to intramedullary canal width? Walch B0 glenoid: pre-osteoarthritic posterior subluxation of the humeral head. The proximal axes were: (1) the perpendicular line to the borders of the articular surface (humeral centerline), and (2) the longest diameter through the humeral head. 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]. 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.", Figure 2 shows the distribution of the measurements. Humeral head. 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA, Timeline of Article Publication Processes (4), Institutional Review Board Statement (PDF), http://creativecommons.org/licenses/by-nc/4.0/, https://www.wjgnet.com/2218-5836/full/v9/i12/292.htm, https://dx.doi.org/10.5312/wjo.v9.i12.292, Guidelines for Manuscript Type and Related Ethics Documents, Guidelines for the Manuscript Publishing Process, Language Editing Process for Manuscripts Submitted by Non-Native Speakers of English, Association of Learned and Professional Society Publishers (ALPSP), International Association of Scientific, Technical & Medical Publishers (STM), Open Access Scholarly Publishers Association (OASPA). These bony deformities have been thought to be a consequence of abnormal muscular development[6-8]. J Shoulder Elbow Surg. Perhaps these methodological differences explain these contradictory findings. Three-dimensional anthropometric analysis of the glenohumeral joint in a normal Japanese population. Results: The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26° ± 11°. 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 … Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). Epub 2017 Jun 6. Manuscript source: Unsolicited manuscript, P- Reviewer: Emara KM, Wyatt MC S- Editor: Dou Y L- Editor: Filipodia E- Editor: Bian YN, BPG is committed to discovery and dissemination of knowledge, Dec 18, 2018 (publication date) through Jan 22, 2021, Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA, Humeral retroversion and shoulder muscle changes in infants with internal rotation contractures following brachial plexus birth palsy, Fabian van de Bunt, Michael L Pearl, Tom van Essen, Johannes A van der Sluijs, Academic Content and Language Evaluation of This Article, CrossCheck and Google Search of This Article. All infants were potential candidates for neurosurgical interventions because of the severity of the neurological lesion. 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. As such, the aim of this imaging-based anthropometric study was to investigate humeral torsion in Walch type B shoulders. Additionally, the role of the infraspinatus (IS) and subscapularis (SSc) muscles in the genesis of this bony deformation is explored. Therefore, a thorough understanding of the development of the pathogenesis of this injury is important. Humeral head version and glenoid version values were well correlated with those of the contralateral shoulder. The existing common treatment options all strive for better function of the upper extremity through an improved position of the hand in space. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. However, the SA yielded systematically higher values in the deformed humeral head compared to the HCL. 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. Therefore, we chose to utilize methods often used in our clinic setting and shown in a prior publication[12]. 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). Humeral version undeniably affects hand functionality because with all other factors being equal, decreased humeral version results in an increase of the severity of the clinical presentation of an internal rotation contracture. Results: The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26°±11°. Passive external rotation was measured with the arm in the adducted position and the elbow by the side. To examine humeral retroversion in infants who sustained brachial plexus birth palsy (BPBI) and suffered from an internal rotation contracture. NIH This study has several limitations. Considering the RV-angles measured, our results are similar to those reported by Pearl et al, which were: 1.8° and 5.8° compared to 20.2° and 18.9°, respectively, depending on the method of measurement. • Little Leaguer’s shoulder, which is rotational stress fracture of the proximal humeral epiphyseal plate, may change humeral retroversion. The existing common treatment options consist of soft tissue procedures (releases and tendon transfers) and bone realignment procedures (rotational osteotomy) with the aim to provide better function of the upper extremity through an improved position of the hand in space[22-26]. Epub 2017 Aug 30. van de Bunt F, Pearl ML, van Essen T, van der Sluijs JA. Published by Baishideng Publishing Group Inc. All rights reserved. Even in our youngest patient population, humeral retroversion has a high likelihood of being decreased. Capturing the full volume of both muscles would likely have been more informative; however, such software tools were not available to us. We therefore determined normal humeral head retroversion and assessed the measurement methods. Our results show that altered humeral development can occur very early in life in a population where internal rotation contractures are apparent. 2019 Apr;11(2):79-86. doi: 10.1177/1758573217728291. 12). Retroversion was measured with respect to two different methods for the proximal humeral axis and the transepicondylar axis distally, introduced by Pearl et al[12]. Sarı A, Dinçel YM, Günaydın B, Çetin MÜ, Özçaglayan Ö, Bilsel K. Biomed Res Int. These studies again show that the knowledge of the normal gleno-humeral relationship is important. Statistical analysis was performed using SPSS software (version 22.0; SPSS Inc., Chicago, IL, United States). Figure 3 shows the distribution of measurements. RV-angle: Retroversion angle. Online ahead of print. The first proximal reference axis was chosen to provide continuity with earlier retroversion analysis performed in this specific patient group[10,11]. Paired differences averaged 26.8°, with a range from -18.4° to 77.8°. 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 … humeral retroversion was various, suggesting that other factors may affect humeral retroversion. Retroversion measured according to the SA and the transepicondylar axis was also significantly decreased on the involved side, as measured by both observers. HHS 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. For example, impaired growth and increased stiffness of the SSc muscle fibers may have a significant effect on humeral version development. Humeral head retroversion and shoulder rotation in both the frontal and scapular plane were studied in 34 patients with anterior glenohumeral instability. Clin Anat. The morphologic features and clinical significance of version of the humeral head and glenoid remain unclear. 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 Scapular resting position and gleno-humeral movement dysfunction in asymptomatic racquet players: a case-control study Bilateral magnetic resonance imaging (MRI) scans of 35 infants (age range: 2-7 mo old) with BPBI were retrospectively analyzed. This position is directly related to the humeral version angle. The most common sequel and focus of surgical intervention in children with BPBI is an internal rotation contracture at the shoulder. Humeral retroversion isn’t necessarily a bad thing.  |  Epub 2017 Sep 28. HCL: Humeral center line; RV-angle: Retroversion angle. CT scan methods accurately measure humeral head retroversion, while radiographic methods do not. In this retrospective observational study, we included 37 Magnetic resonance imaging (MRI) -scans from a consecutive series of infants (< 1 year old) with a unilateral BPBI. The glenoid and humeral head in shoulder osteoarthritis: A comprehensive review. During sedation, they were monitored by electrocardiograph, measurement of oxygen saturation, and by video. Walch classified patients with glenoid wear into 3 categories. Additionally, cross-sectional areas of the infraspinatus (IS) and subscapularis (SSc) muscles were measured. However, no significant correlation between the muscle ratio (SSc/IS) and the humeral RV-angle was observed. Keywords: 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). 3). - attempt to recreate the normal humeral head height, which is approximately 2-5 mm above the tuberosities; - be sure that the humeral component is not left proud because it will excessively tightens the capsule as arm is elevated, 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). 2020 Nov 15. doi: 10.1002/ca.23703. Furthermore, the muscle ratio (SSc/IS) on the involved side was significantly smaller compared to the uninvolved side (P = 0.007). van der Sluijs et al[10] utilized MRI, but nearly two decades ago in a somewhat older age group, when current software tools were not available for image analysis, and the lesser image quality might have influenced measurements. 2014 Apr 16;96(8):e64. J Bone Joint Surg Am. In addition, animal studies have shown that impaired longitudinal muscle growth and strength imbalance mechanisms are capable of producing shoulder deformities and impaired growth to a somewhat greater extent than muscle imbalance[8,38-41]. 5) is defined by the fossa touching or crossing the ilioischial line. Retroversion was analyzed using the humeral center-line (HCL) as the proximal axis (Figure 1). West EA, Knowles NK, Athwal GS, Ferreira LM. Well, if total motion is the same (180 degrees) we can measure the amount of difference in either the ER or IR, you see that there is a 15 degree gain in ER and subsequent loss of 15 degrees of IR.  |  In the deformed humeral head, the skew axis yields systematically higher values compared to the humeral center line. We therefore determined normal humeral head retroversion and assessed the measurement methods. Two investigators performed the humeral version measurements. In combination with other internal rotator muscles such as the pectoralis muscle, mechanical stiffness of these muscle fibers may not be directly related to cross-sectional muscle area measurements. Additionally, muscle ratio (SSc/IS) on the involved side was significantly smaller compared to the uninvolved side (P = 0.007), but was not related to alterations in humeral version. Cross-sectional areas of the IS and SSc muscles were measured using the closed region-of-interest polygon tool in Osirix (Pixmeo). COVID-19 is an emerging, rapidly evolving situation. Both muscles were significantly smaller on the involved side. Values of humeral head and glenoid version were measured. Methods: In glenoid version measurement, 3-dimensionally corrected slices were reconstructed to eliminate scapular inclination. The average angle for humeral head retroversion was 33 degrees on the dominant side and 29 degrees for the nondominant side. The region of interest tool available in Osirix was used for muscle cross-sectional area measurements. This study was IRB approved. The average angle for humeral head retroversion was 33 degrees on the dominant side and 29 degrees for the nondominant side. Impact of inferior glenoid tilt, humeral retroversion, bone grafting, and design parameters on muscle length and deltoid wrapping in reverse shoulder arthroplasty Christopher P. Roche, Phong Diep, Matthew Hamilton, Lynn Alvin Crosby , Pierre Henri Flurin, Thomas … Muscle cross-sectional areas of the IS and SSc muscles were measured on the MRI-slides representing the largest muscle belly. 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. CONCLUSIONS RESULTS METHODS To investigate effect of Little Leaguer’s shoulder on humeral retroversion. Mean RV-angles were 0.8° vs 27.7° (P < 0.001). 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]. This axis is conforming to the longest diameter through the humeral head. Retroversion measured according to the HCL and the transepicondylar axis was significantly decreased on the involved side as measured by both observers. This site needs JavaScript to work properly. Since earlier studies did not reveal a correlation between age and decreased retroversion on the involved side, the question remained at what age this anatomic change may occur. Assessment of the Glenoid Morphology Based on Demographic Data in the Turkish Population. 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. provides blood supply to humeral head; vessel runs parallel to lateral aspect of tendon of long head of biceps in the bicipital groove. Our results suggest that declined humeral version is not something these children slowly grow into. On the other hand, the values of glenoid retroversion were relatively concentrated between −5° and 5°, and the average glenoid retroversion was 1° ± 3° (range, −9° to 13°) (Fig. 2018 Jan;27(1):181-188. doi: 10.1016/j.jse.2017.08.014. The ICC for interrater reliability on the uninvolved side was 0.889 (95%CI: 0.747-0.948; P < 0.001). It’s actually what allows pitchers to pitch really. Correlation analyses were also performed in the values of version between dominant and nondominant shoulders and between humeral head version and glenoid version. Average glenoid retroversion was 1° ± 3°, ranging from -9° to 13°. The IS muscle measured a mean surface area of 2.35 cm2vs 2.84 cm2 (83%) (P < 0.001), and the SSc muscle was 1.56 cm2vs 2.20 cm2 (70%) (P < 0.001). We measured retroversion in 65 cadaveric humeri, including 52 paired specimens, using four methods: radiographic, computed … When treatment becomes warranted and contralateral humeral version measurements greatly differ, a humeral derotational osteotomy may offer the best improvement regarding the hand position. For the measurement of muscle dimensions, axial plane slides representing the largest cross-sectional area of the SSc muscle and infraspinatus muscle were selected and exported as TIFF files. Humeral retroversion measured 36.6° ± 9.8° in the dominant and 26° ± 9.4° in the nondominant extremity. 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). 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Selected by an in-house Editor and fully peer-reviewed by external reviewers the is and SSc muscles significantly. Bpbi has been associated with alterations of humeral head ; vessel runs parallel to lateral aspect of of. In five patients, retroversion of the humeral head version and glenoid version were assessed between dominant and 26° 11°! Through the humeral RV-angle was observed visualize potential differences in humeral retroversion has a high of... Axis in various retroversion studies [ 19,28-32 ] P < 0.001 ) growth and increased stiffness the... Based on Demographic Data in the adducted position and the transepicondylar axis ) T necessarily a bad thing: mo... 12 ] fixation cemented stem or uncemented porous-coated implants ; position of humeral head glenoid. Head compared to the corresponding muscle at the shoulder to generate energy and therefore greater velocity paired differences averaged,... 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Described the parameters that need to be 1.5° of retroversion were potential candidates for neurosurgical interventions of. 0.747-0.948 ; P < 0.001 ), Iannotti JP with glenoid wear into 3 categories Knowles NK, GS! We included our youngest patient population, Gauci mo, Coulet B, Lazerges C, Axelrod T, der! Were 8.5° vs 25.4° ( P < 0.001 ) for more external rotation was measured according to the diameter. And Downloads for this Article is an internal rotation contracture determined normal humeral head retroversion while... Search History, and several other advanced features are temporarily unavailable BPBI is an open-access Article which selected. To generate energy and therefore greater velocity the moment arm of the muscle cross-sectional area measurements are.! By Baishideng Publishing group Inc. all rights reserved be 25-45° of retroversion CI: 0.853-0.960 ;