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). - 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 … 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]. However, this has not yet been related to altered humeral version. 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. Epub 2017 Jun 6. USA.gov. All infants were potential candidates for neurosurgical interventions because of the severity of the neurological lesion. Interest in the glenoid hull method for analyzing humeral subluxation in primary glenohumeral osteoarthritis. 2018 Jan;27(1):181-188. doi: 10.1016/j.jse.2017.08.014. In this scenario the amount of humeral retroversion is 15 degrees. Muscle size was determined by the muscle cross-sectional area in cm2 and muscle percentage relative to the corresponding muscle at the uninvolved side. Furthermore, the muscle ratio (SSc/IS) on the involved side was significantly smaller compared to the uninvolved side (P = 0.007). 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). The Narakas classifications were assigned as described by Narakas[27]. Epub 2017 Mar 31. The retroversion of the humerus was measured by determining the orientation of the proximal articular surface of the humerus with respect to the transepicondylar line of the distal part of the humerus and the forearm axis. 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 … The TIFF files were imported into Geometer’s Sketchpad version 5.03 (KCP Technologies, Emeryville, CA, United States) for further retroversion analyses. 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. These bony deformities have been thought to be a consequence of abnormal muscular development[6-8]. The distribution of measurements was larger on the involved side (Figure 4).  |  Average glenoid retroversion was 1° ± 3°, ranging from -9° to 13°. 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). Both muscles were significantly smaller on the involved side. Please enable it to take advantage of the complete set of features! Shoulder Elbow. The difference in retroversion was correlated with the ratio of muscle-sizes and passive external rotation measurements. Furthermore, the muscle ratio (SSc/IS) at the involved side was significantly smaller compared to the uninvolved side (P = 0.007). Images for analysis were computed tomography scans of 410 normal shoulders from healthy volunteers. Muscle cross-sectional areas of the IS and SSc muscles were measured on the MRI-slides representing the largest muscle belly. Further study of other muscles is warranted, looking for evidence as to whether they were also injured resulting in impaired growth[7,37], or whether they recovered so strongly that they overwhelmed their antagonists or are used differently in children with varying levels of recovery. Additionally, the role of the infraspinatus (IS) and subscapularis (SSc) muscles in the genesis of this bony deformation is explored. 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. During sedation, they were monitored by electrocardiograph, measurement of oxygen saturation, and by video. Humeral retroversion and shoulder muscle changes in infants with internal rotation contractures following brachial plexus birth palsy. The center of rotation of the normal humeral head is, on 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. Walch B0 glenoid: pre-osteoarthritic posterior subluxation of the humeral head. In the deformed humeral head, the skew axis yields systematically higher values compared to the humeral center line. 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. Checklist of Responsibilities for the Scientific Editor of This Article. 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. 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.", Particular attention was focused on humeral head retroversion, shoulder stability, and range of motion in relation to surgical technique. NIH 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. 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]. West EA, Knowles NK, Athwal GS, Ferreira LM. 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. Fabian van de Bunt, MD, MSc, Doctor, MD, Department of Orthopedics, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, Netherlands. Clipboard, Search History, and several other advanced features are temporarily unavailable. We therefore determined normal humeral head retroversion and assessed the measurement methods. 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. Based on the literature, retroversion of the humeral head is shown as a positive value and anteversion is shown as a negative value. 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. Age did not correlate with a decrease in humeral retroversion (r = -0.108, P = 0.538). 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 ] . NLM Core tip: This study examines humeral retroversion in infants who sustained neonatal brachial plexus palsy and suffered from an internal rotation contracture. They studied this relationship as correlations between lines at the humeral and at … See: Times Cited Counts in Google of This Article, Number of Hits and Downloads for This Article. © 2004-2021 Baishideng Publishing Group Inc. All rights reserved. Results depend on proper implant selection, posit… Methods: 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. Our main goal was to further elucidate the timing that these anatomic changes may occur; therefore, we included our youngest patient population. provides blood supply to humeral head; vessel runs parallel to lateral aspect of tendon of long head of biceps in the bicipital groove. Humeral head retroversion is not well described with the literature controversial regarding accuracy of measurement methods and ranges of normal values. The region of interest tool available in Osirix was used for muscle cross-sectional area measurements. It’s actually what allows pitchers to pitch really. Normal depth is defined as acetabular fossa lateral to the ilioischial line. Retroversion was measured according to two proximal axes and one distal axis (transepicondylar axis). Epub 2017 Sep 28. 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. ascending branch of anterior humeral circumflex artery and arcuate artery . The existing common treatment options all strive for better function of the upper extremity through an improved position of the hand in space. Glenoid reconstruction can be challenging, especially if wear has caused changes in the glenoid morphology. Bilateral magnetic resonance imaging (MRI) scans of 35 infants (age range: 2-7 mo old) with BPBI were retrospectively analyzed. We therefore determined normal humeral head retroversion and assessed the measurement methods. This is supported by the lack of significant correlation found between age and decreased retroversion on the involved side in both studies. A number of studies have described the parameters that need to be restored while performing a shoulder arthroplasty. The HCL represents the perpendicular projection from the margins of the articular surface. 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]. The glenoid and humeral head in shoulder osteoarthritis: A comprehensive review. Coxa profunda (Fig. 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]. Paired differences averaged 17.5°, with a range from -22.2° to 53.3°. Our objective was to elucidate the timing that decreased retroversion may occur; therefore, we included our youngest patient population (2-7 mo old). 2018 Jul;10(3):192-200. doi: 10.1177/1758573217711897. Of further note, the earliest reports by Scaglietti[11] and van der Sluijs et al[10] found an increase in retroversion. 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. Walch classified patients with glenoid wear into 3 categories. Matsumura N, Oki S, Ogawa K, Iwamoto T, Ochi K, Sato K, Nagura T. J Shoulder Elbow Surg. Published by Elsevier Inc. All rights reserved. Background: 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 … This study was IRB approved. the lateral humeral offset to optimize the moment arm of the deltoid muscle and the rotator cuff. In two patients, retroversion increased on the involved side (Table 1). Statistical analysis was performed using SPSS software (version 22.0; SPSS Inc., Chicago, IL, United States). Our results suggest that declined humeral version is not something these children slowly grow into. CT scan methods accurately measure humeral head retroversion, while radiographic methods do not. 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). 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. The distribution analysis showed an approximately normal distribution. With greater retroversion of the humerus, there is the potential for more external rotation. Retroversion was analyzed using the humeral center-line (HCL) as the proximal axis (Figure 1). Anatomical shoulder arthroplasty for osteoarthritis has shown consistent and good results in shoulder with a rotator cuff-intact glenohumeral joint. Figure 2 shows the distribution of the measurements. This study has several limitations. 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). 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). 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. 2018 Sep 12;5(1):35. doi: 10.1186/s40634-018-0148-2. Results: The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26°±11°. This site needs JavaScript to work properly. Bouacida S, Gauci MO, Coulet B, Lazerges C, Cyteval C, Boileau P, Chammas M. J Shoulder Elbow Surg. Retroversion measured according to the HCL and the transepicondylar axis was significantly decreased on the involved side as measured by both observers. 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. Keywords: The altered humeral version angle may already develop within the first weeks after birth, when the humerus is probably most prone to altered development caused by altered muscle forces gripping the humeral head. However, the mean age of the study groups differed considerably, 3.2 years old vs 4.3 mo old. Figure 3 shows the distribution of measurements. Both measurement methods yielded comparable results in the uninvolved shoulder. 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. The MRI slides depicting the largest muscle bellies were identified for measurement of this cross-sectional area. Perhaps these methodological differences explain these contradictory findings. Published by Baishideng Publishing Group Inc. All rights reserved. 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. 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. J Bone Joint Surg Am. Humeral stem fixation cemented stem or uncemented porous-coated implants ; position of humeral stem should be 25-45° of retroversion . Two investigators performed the humeral version measurements. Therefore, we chose to utilize methods often used in our clinic setting and shown in a prior publication[12]. The difference in retroversion was correlated with the ratio of muscle sizes. Clin Anat. - 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, When treatment becomes warranted and contralateral humeral version measurements greatly differ, a humeral derotational osteotomy may offer the best improvement regarding the hand position. Both the humeral head and glenoid are thought to be more retroverted in high-demand shoulders. These studies again show that the knowledge of the normal gleno-humeral relationship is important. 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. Scaglietti’s study was in a very different era of imaging technology and presented his observations with little quantitative data. 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. RV-angle: Retroversion angle. The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26° ± 11°. This axis is conforming to the longest diameter through the humeral head. Epub 2015 Oct 23. A Bland-Altman plot was created to visualize potential differences in retroversion measuring methods[33]. Shoulder morphology; glenoid morphology; glenoid retroversion; humeral head retroversion; humeral torsion; humerus morphology; shoulder arthroplasty. Epub 2017 Aug 30. van de Bunt F, Pearl ML, van Essen T, van der Sluijs JA. HHS 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. doi: 10.2106/JBJS.L.00856. Average glenoid retroversion was 1° ± 3°, ranging from -9° to 13°. These findings are relevant for any child under consideration for surgical intervention aiming to improve external rotation, since all other factors being equal, decreased humeral retroversion results in an increased severity of the clinical presentation of an internal rotation contracture. In five patients, retroversion was increased on the involved side (Table 1). A trend (b P = .058) toward greater humeral retroversion was also observed in the nondominant arm of Latin American compared with North American pitchers. The retroversion angle 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. Results: The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26° ± 11°. 2017 Jul;26(7):1128-1136. doi: 10.1016/j.jse.2017.01.027. 5) is defined by the fossa touching or crossing the ilioischial line. Altered humeral retroversion warrants attention as a structural change in any child being evaluated for the treatment of an internal rotation contracture. More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. While the software tools currently exist, they are labor intensive and extremely difficult to implement in clinical practice. 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. 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 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. So the humerus must be retroverted 15 degrees. Age was again not correlated with a decrease in humeral retroversion (r = -0.120, P = 0.492). Barth J, Garret J, Boutsiadis A, Sautier E, Geais L, Bothorel H; Shoulder Friends Institute, Godenèche A. J Exp Orthop. Scapular resting position and gleno-humeral movement dysfunction in asymptomatic racquet players: a case-control study Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Retroversion measured according to the SA and the transepicondylar axis was also significantly decreased on the involved side, as measured by both observers. HCL: Humeral center line; RV-angle: Retroversion angle. Conclusions: Furthermore, this study shows that secondary osseous changes can occur within several months in this patient population. Ml, van Essen T, Ochi K, Iwamoto T, Nam D. shoulder Elbow Surg N Oki... In humeral retroversion in infants who sustained neonatal brachial plexus birth palsy Germany.... Child being evaluated for the nondominant side the perpendicular projection from the margins of the pathogenesis of this Article number! 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