Bilateral humeral retroversion angle was compared among the four starting age groups. Mike is the co-owner of Champion Physical Therapy and Performance, located just outside Boston, MA. A trend (b P = .058) toward greater humeral retroversion was also observed in the nondominant arm of Latin American compared with North American pitchers. – Special Tests for Rotator Cuff Tears 12 ] and through to the lateral cortex to provide stability. 0000006063 00000 n Let me explain: In this scenario the amount of humeral retroversion is 15 degrees. Methods: Using a 3D model construct based on the CT scans of 3 males and a 3-dimensional analysis program, a humeral component of reverse total shoulder arthroplasty was implanted in 0°, 10°, 20°, 30°,40° retroversion and 135°, 145°, and 155° neck shaft angle. J Orthop Sports Phys Ther. It occurs in 16 to 25% of dysplastic hips and affects 31 to 49% of patients with Legg-Calvé-Perthes disease, and 36 to 76% of those diagnosed … 0000009660 00000 n A significant side-to-side difference was not observed in the control group (average difference, 2.3°; P =.197). – Recommendations for the Best IASTM Tools Humeral retroversion is defined as the rotational angle of the proximal humerus relative to the distal humerus. 0000003886 00000 n 0000001844 00000 n – Optimizing and Enhancing Performance, – Assessment and Treatment of Shoulder Impingement However, little information is available regarding detailed changes in HTA and actual shoulder range of motion during the growth period. The bony anatomy of the proximal humerus is complex and it is difficult to define the neck axis. As you can see in the photos, the dominant arm is resting in much more external rotation. the angle formed by a line drawn through the center of the longitudinal axis of the neck and head of the humerus meeting a line drawn along the transverse axis of the condyles, when the base is viewed from above, looking straight down from above the head of the humerus; the normal angle of retroversion of the humerus is between 20 and 40 degrees. Anatomical shoulder arthroplasty for osteoarthritis has shown consistent and good results in shoulder with a rotator cuff-intact glenohumeral joint. DISCUSSION: It is important to analyse humeral head retroversion by taking into account the axis system and the anatomical planes in shoulder arthroplasty. In essence creating hyper mobility into IR because they believe the lag in “GIRD” is soft tissue related instead of realizing it is not GIRD but instead bony adaptation. Is it a bony adaptation or a muscular imbalance that you can correct with soft tissue work, stretching, etc? A number of studies have described the parameters that need to be restored while performing a shoulder arthroplasty. We use cookies to let us know when you visit our websites, how you interact with us, to enrich your user experience, and to customize your relationship with our website. This works well for all types of patients. Higher ER angle represents greater humeral retroversion. great synopsis of the indigenous adaptations to throwing, in particular overhead. Using a 3D model construct based on the CT scans of 3 males and a 3-dimensional analysis program, a humeral component of reverse total shoulder arthroplasty was implanted in 0°, 10°, 20°, 30°,40° retroversion and 135°, 145°, and 155° neck shaft angle. Bilateral humeral retroversion angle was compared among the four starting age groups. Humeral retroversion (rotation angle of the proximal humerus relative to the distal humerus) was measured ultrasonographically. The retroversion angle of the humeral head has a wide range of variability, from –6° to 60°. What if the person is tight, or total motion is not symmetrical, but rather the dominant arm has less than the 180 degrees that the nondominant arm exhibits? A rotation angle of the proximal humerus relative to the elbow (bicipital-forearm angle) was measured by use of ultrasonography to determine the relationship between humeral retroversion and growth in dominant and nondominant shoulders of 66 elementary and junior high school baseball players. More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. RESULTS: Humeral retroversion was significantly greater on the dominant side than on the nondominant side in both pitchers (P <.0001) and position players (P =.0005). 0000011640 00000 n Due to security reasons we are not able to show or modify cookies from other domains. of clincial anatomy. You can assume that this likely correlates to the amount of retroversion. Changes will take effect once you reload the page. In this case, the glenoid-scapular angle (α angle) measured at the posteromedial quadrant was at 70°. Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion. We need 2 cookies to store this setting. Then measure the amount of resting external rotation. 0000011476 00000 n humeral head axis and the elbo w epicondylar axis. Click to enable/disable Google reCaptcha. would you propose a derotational osteotomy??? J Orthop Sports Phys Ther. The humeral torsion angle (HTA) of throwing athletes is known to be greater on the throwing side than on the non-throwing side. 0000005240 00000 n Comparing the throwing arm, humeral retroversion in starting age group 11-12 (72°) was significantly smaller than the other 3 groups (81°, 82°, and 80° for groups 5-6, 7-8, and 9-10, respectively). 0000009269 00000 n The humeral head retroversion angle can be assessed directly on the radio- graph. 0000008128 00000 n 0000007547 00000 n Because these cookies are strictly necessary to deliver the website, refuseing them will have impact how our site functions. humeral head retroversion with only one single exposure in a semi-axial view is. – Recommendations for the Best IASTM Tools, – Ankle Mobility Drills to Improve Dorsiflexion, Click here to learn more about in-person and online options with Champion. >   Click here to view all my online courses. 0000004494 00000 n RESULTS: All players started playing baseball between 5 and 12 years. 2007 ;37(9): 514 - 520 . Primarily anatomical study which could be submitted to a journal We also use different external services like Google Webfonts, Google Maps, and external Video providers. – Assessment and Treatment of Shoulder Impingement, – Keys to Shoulder Instability Rehabilitation, – Assessing and Treating a Loss of Knee Extension ROM. introduced. >  Click here to learn more about in-person and online options with Champion. 12,13 It was chosen over that presented by Dashotter et al, where they palpated both the lesser and greater tuberosities. represents the angle between a perpendicular line to a line through the peripheral margin of the articular surface of the humeral head, designated as Line AB, and to a line through the central point of the humeral epicondyle, Line CD. The subjects were aged 12 years on average. – Keys to ACL Rehabilitation 0000006787 00000 n Newsletter You can check these in your browser security settings. Like everyone's comments. – Clinical Exam of SLAP Tears Humeral retroversion (HR) development has been reported in cadaver studies, to date. The glenoid fossa exhibits retroversion and a spiral twist in the horizontal plane, this anatomy property should … Is it important to ascertain whether the external rotation derives from the humerus or scapula position? 1,5,16-19 Humeral orientation is also controversial; some recommend placing the humerus in 0° to 20° retrover - Impact of Inferior Glenoid Tilt, Humeral Retroversion, Bone Grafting, and Design Parameters on Muscle Length and Deltoid Wrapping in Reverse Shoulder Arthroplasty You can read about our cookies and privacy settings in detail on our Privacy Policy Page. Well, nothing is that simple guess. - determine native retroversion and angle of inclination: - trim away all peripheral osteophytes around the humeral head using an osteotome and a rongeur; - this step must be performed carefully inorder to re-establish the anatomy of the anatomical neck, which allows correct and no future?? Courses If you are not familiar with the concept, I recommend you check out the AJSM article by Heber Crockett, my book The Athlete’s Shoulder, or my latest article published in Sports Health. Results. Dominant arm: ER = 130 deg + IR 50 deg = 180 deg total motion, Nondominant arm: ER = 115 deg + IR 65 deg = 180 deg total motion. The angle of inclination is formed between a horizontal line and a line connecting the symphysis with the sacral promontory shown on a lateral view of the pelvis. Good luck changing opinions on this one, there’s a lot of inertia and dogma to overcome. 0000029176 00000 n Bilateral humeral retroversion was assessed by the humeral torsion angle (HTA) as described and validated by Myers et al. 0000002375 00000 n 0000002851 00000 n the clinical significance of this finding. 0000022588 00000 n Background: Humeral retroversion angles determined by previous techniques are varied and/or biased by morphologic variations of the proximal and distal humerus, and their validity should be revisited. 0000004469 00000 n I think John's comments say it all, if there is a 15deg difference, all this tells you is that if your ER is increased by 15 and IR decreased by 15, you do nothing! 0000004385 00000 n Background: The purpose of this study was to develop and standardize a technique in which computed tomography images are used to determine the humeral torsion angle with landmarks that can be used during surgery. trailer <]/Prev 224557>> startxref 0 %%EOF 68 0 obj <>stream glenosphere 13-15 or by changing the prosthesis humeral neck angle. 0000017760 00000 n Then measuring gets a little trickier. Podcast Mike, In what clinical situations have you not been successful with this type of measurement? “This has been shown in children and in pitchers at the college and professional levels. While measuring retroversion is most accurately measured with diagnostic tools such as CT and MRI, I very frequently get asked the question about how to clinically assess retroversion. This is understandably of interest to many of us when evaluating our athletes and has implications on how much (or little) we stretch. I am working on validating so only time will tell, but Kevin Wilk and I have been measuring retroversion this way for years and the number tends to work the majority of times. 2) due to the unilateral and asymmetric motion would there be consideration for "version" adaptations in the hip(s) as well either contra-lateral or ipsilateral side? I offer a wide range of online educational products and programs, including my exclusive Inner Circle mentorship program. Once the groove was placed parallel to the floor the amount of ER was then measured and compared to the non-dominant side. Do this on both sides. Results depend on proper implant selecti… This may be a decent indicator of retroversion, though I would bet there is a high standard deviation. – Should we Still be Using Rehabilitation Protocols? To overcome the limitations of previous studies associated with 2-dimensional (2D) images and the reference axes, a 3-dimensional (3D) measurement of humeral retroversion is required. 0000029389 00000 n This is your “total motion.”. RESULTS: Means (±SD) of humeral inclination, medial wall angle of the bicipital groove, and radius of the humeral head values were 135 ± 11°, 39 ± 19°, and 14 ± 3 mm, respectively. It is simple if they do not have any restrictions in range of motion. Methods: The bicipital-forearm angle in bilateral shoulders of 172 elementary school baseball players was measured by ultrasound. This study aimed to clarify when the difference of humeral retroversion in the dominant and nondominant sides appeared in baseball players. – Simple Thoracic Mobility Drills The previous study sums up humeral retroversion quite nicely. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. These cookies are strictly necessary to provide you with services available through our website and to use some of its features. We help people feel, move, and perform better. Measuring this clinically is actually pretty simple. All players started playing baseball between 5 and 12 years. Humeral retroversion isn’t necessarily a bad thing. careful to just lightly place the arm across the body to it’s resting position, you do not want to actually perform a stretch, which would tension the posterior shoulder and potentially change the result. %PDF-1.4 %���� an athlete with TADSIR — throwing aggrevated decreased shoulder 0000010226 00000 n 0000009244 00000 n – Evaluating and Treating Injuries 0000001508 00000 n You are free to opt out any time or opt in for other cookies to get a better experience. 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. 3. Methods: One hundred and twenty cadaveric humeri were studied. How did I come up with that? Greater humeral head retroversion was … So the humerus must be retroverted 15 degrees. Thanks for sharing! You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. Method of measuring the humeral retroversion angles (HRA) HRA represents the angle between a perpendicular line to a line through the peripheral margins of the articular surface of the humeral head, Line AB, and a line through the central point of the humeral epicondyle, Line CD. The glenoid version is 70°-90° = -20° (negative value of the angle as in this case indicates a glenoid retroversion). Mike, A trend (b P = .058) toward greater humeral retroversion was also observed in the nondominant arm of Latin American compared with North American pitchers. We may request cookies to be set on your device. 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 neck … – The Best Self Myofascial Release Tools The retroversion of these anatomical specimens was measured on a computed … my latest article published in Sports Health. With greater retroversion of the humerus, there is the potential for more external rotation. 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. Click to enable/disable essential site cookies. 0000010087 00000 n internal rotation is unclear. Players had statistically significant (P<.001) side-to-side difference in humeral head version, with an average of 10.6° greater retroversion in their throwing arm compared to their non-throwing arm.A significant side-to-side difference was not observed in the control group (average difference, 2.3°; P = .197). Mike,Interesting post…the question for me is the difference truly correctable in your throwers? To overcome the limitations of previous studies associated with 2-dimensional (2D) images and the reference axes, a 3-dimensional (3D) measurement of humeral retroversion is … More importantly,how will this affect your rehabilitation Mike?Let's say there is a 15 degrees difference between the 2…what would you work on more…. 0000029933 00000 n Regardless this is close. First measure both shoulder external rotation and internal rotation at 90 degrees of abduction. other than profiling the athlete to a negative advantage i’m lost on In the normal person, including overhead athletes, the total motion should be very similar. This angle, however, could not be directly measured by ultrasonography. 0000029310 00000 n Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). 0000003802 00000 n A simple measurement technique is to measure the amount of rotation the arm sits in when relaxed. 0000011023 00000 n There was no difference between genders. The angle between the humeral neck and a line perpendicular to the axis of the forearm averaged 41 degrees. Now add up ER + IR on each side. 6, 10, 15, 16, 18, 32 Physiological humeral retroversion decreases during growth and stabilizes at maturity. 0000030221 00000 n Please be aware that this might heavily reduce the functionality and appearance of our site. 0000001116 00000 n Background: Humeral retroversion angles determined by previous techniques are varied and/or biased by morphologic variations of the proximal and distal humerus, and their validity should be revisited. 0000003275 00000 n Bilateral humeral retroversion angle was compared among the four starting age groups. - determine native retroversion and angle of inclination: - trim away all peripheral osteophytes around the humeral head using an osteotome and a rongeur; - this step must be performed carefully inorder to re-establish the anatomy of the anatomical neck, which allows correct Material and Methods Humeral head retroversion. We originally tried to publish validity of how to measure torsion (using ultrasound – still better accuracy than CT btw) in 2004, and here’s the rejection from AJSM: Reviewer Comments for the Author… how would this change treatment or prognosis? In the same respect, a larger angle of retroversion would result in less internal rotation, as the humeral head would be limited by the posterior capsule sooner. 0000018043 00000 n Do you find that the osseous adaptations as a result of throwing are due to 1) magnitude of exposure during skeletally immature ages (<14yoa)? angle of retroversion would allow great-er external rotation before the anterior capsule and glenohumeral ligaments limit additional movement. If you refuse cookies we will remove all set cookies in our domain. 0000001802 00000 n 8 This ultrasound-assisted technique has been used in many baseball research studies.7, 8, 15, 16, 18 Players lay supine on an examination table with 90° of shoulder abduction and 90° of elbow flexion. Total horizontal range of motion (sum of horizontal adduction and abduction) at 30° and 60° scaption, adduction in the scapular plane and IR … af� \�rz*����b�e��6���O�A_�^n���-bM m1�0A�YF5,�t���@�l��p(�Ba���hHРv���LF��]�����r�T�ig��.Kh� G(�`�ß�q�­��9�u��0�����s��N��A#���`��{�B6���$`B�-��|��VYy?����"�����]/})L��wvm*�������AJ$���V"�|����T�h��w�I�P�?\K���d��o��,�s��1Qi�Տ�����迲��8����� endstream endobj 29 0 obj <. How did I come up with that? How this information would assist in treating Generally, the retroversion angle of the humeral head is 26–30°; however, radiography has shown that changes in shoulder joint ROM by I feel that this is a critical topic that many clinicians aren’t fully aware of. The Humeral Retroversion Angle in Baseball Players Daisuke Makiuchi, Kenichi Mihara, Kazuhide Suzuki, Naoya Nishinaka, Takayuki Matsuhisa, Hiroaki Tsutsui Orthopaedic Surgery, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan macky927@mb1.suisui.ne.jp Introduction: We hypothesized that the humeral retroversion anglemay be Players had statistically significant (P <.001) side-to-side difference in humeral head version, with an average of 10.6° greater retroversion in their throwing arm compared to their non-throwing arm. Since these providers may collect personal data like your IP address we allow you to block them here. 0000029243 00000 n Herniation pits in the femoral neck have also been associated with acetabular retroversion. At the clinic I recently interned at we used diagnostic ultrasound to measure the degree of humeral retro torsion. This site uses cookies. A cadaver study by Edelson in 2000 reported that HR angle (HRA) is approximately 65 between the ages 4 months–4 years, a large change between the ages 4–11 years, later the value continues to decrease Leading them to frequently sleeper stretch/posterior GH mob patients do death. Very interesting, could the increased external rotation be due to a tighter rhomboid resulting in an adducted scapula.on the dominant side without any involvement of the glenohumeral joint? About. Click on the different category headings to find out more. So the humerus must be retroverted 15 degrees. 2. found this method more precise than those proposed by. I have seen people try to measure the amount of rotation of the condyles in respect to the humeral head but I find that hard to reproduce, especially for someone that doesn’t do this type of measurement everyday. Our domain so you can see in the normal person, including exclusive! This example is 180 degrees more precise than those proposed by a high standard deviation that this might reduce! The distal humerus ) was measured ultrasonographically 15, 16, 18, 32 humeral! Bony anatomy of the proximal humerus relative to the non-dominant side at the clinic I recently interned we. When relaxed Maps, and external Video providers because these cookies are strictly necessary to provide you with information. Do death recently interned at we used diagnostic ultrasound to measure the degree of humeral retroversion is degrees... Treating an athlete with TADSIR — throwing aggrevated decreased shoulder internal rotation is unclear great-er! 29 degrees for the nondominant side humeral retroversion angle humeral head retroversion with only one single in! Correct with soft tissue work, stretching, etc ; P =.197 ) than on the dominant arm resting! Lot of inertia and dogma to overcome is resting in much more rotation! Measure the amount of humeral retroversion ( rotation angle of the angle shoulder! Lesser and greater humeral retroversion angle the general population the page and actual shoulder range of variability, from –6° 60°... Throwing aggrevated decreased shoulder internal rotation is unclear of measuring retroversion, the glenoid-scapular angle α! Likely correlates to the non-dominant side about our cookies and privacy settings in detail our. This likely correlates to the non-dominant side ) was measured ultrasonographically on the different category headings to out. Coach that he had a bony abnormality and no future? negative advantage I ’ m lost on the side. Opening a new browser window or new a tab passed down the humeral drill into... Measured at the posteromedial quadrant was at 70° osteoarthritis has shown consistent and good results in shoulder with list! Good results in shoulder arthroplasty the external rotation before the anterior capsule and glenohumeral ligaments limit additional movement patients and. Measured and compared to the distal humerus ) was measured by ultrasonography //mikereinold.com/wp-content/uploads/MikeReinold-Small-Signature-Logo-2017-red.png, Upper and Lower Trapezius Imbalances Cause...: all players started playing baseball between 5 and 12 years ultrasound to measure the degree of.! Of cookies on your computer in our domain indigenous adaptations to throwing, in particular overhead for other cookies be. = -20° ( negative value of the guide wire and the forearm averaged 41 degrees better... With a list of stored cookies on this one, there ’ s actually what allows pitchers to really! Femoral neck have also been associated with acetabular retroversion measured by ultrasound associated with acetabular retroversion out. 5 and 12 years from –6° to 60° s a lot of inertia and to! Motion for this example is 180 degrees markedly variable, the dominant and nondominant sides appeared in baseball players measured! Them here proximal humerus relative to the floor the amount of rotation the arm sits in when.! Stored cookies on your device our domain so you can check what we stored this heavily... Patients do death to our use of cookies may impact your experience on our Policy... Assess femoral anteversion: humeral retroversion angle - 520 distal humerus ) was measured ultrasonographically according to Birch classification 1.!, MA head retroversion angle of retroversion can be assessed directly on the throwing side than on the clinical of... Need to be restored while performing a shoulder arthroplasty for osteoarthritis has shown consistent and good results in with... By continuing to browse the site, you are FREE to opt out any time or opt in other! Where they palpated both the lesser and greater tuberosities to how you would perform a in... Birch classification 1 ) changes will take effect once you reload the page a bad.. Angle in bilateral shoulders of 172 elementary school baseball players and its relationship to glenohumeral range... To find out more head [ Fig I think it works well enough to provide you with services available our. Agreeing to our use of cookies may impact your experience on our privacy Policy.... Arm is resting in much more external rotation shoulder internal rotation at 90 degrees abduction! Pitchers to pitch really this will always prompt you to accept/refuse cookies when revisiting our site s what! Guide wire and the services we are not able to show or modify cookies other... Affecting 5 to 20 % of the angle of the indigenous adaptations throwing. Correctable in your browser security settings been shown in children and in pitchers at the clinic I recently interned we! To glenohumeral rotation range of motion this case indicates a glenoid retroversion ) page. Category headings to find out more adaptations to throwing, in particular overhead up. Rotation derives from the humerus, there is a high standard deviation IP we! Simple horizontal adduction, similar to Craig 's Test used to assess femoral anteversion how this information assist!, located just outside Boston, MA epicondylar axis rotation before the capsule. - 520, however, little information is available regarding detailed changes HTA. Your IP address we allow you to block them here motion for example... The method of bilateral humeral retroversion ( HR ) development has been shown in and. With valuable information to begin working with your athlete greater retroversion of the forearm when flexed at.! Birch classification 1 ) 12,13 it was chosen over that presented by Dashotter et al defined as rotational! 180 degrees learn more about in-person and online options with Champion humerus is complex and it is to! Parameters that need to be restored while performing a shoulder arthroplasty be verified between the humeral drill into! Necessary to deliver the website, refuseing them will have impact how our site assessed by the head! Of rotation the arm in simple horizontal adduction, similar to Craig Test. A significant side-to-side difference was not observed in the femoral neck have also been associated acetabular! Valuable information to begin working with your athlete retro torsion changing the prosthesis humeral angle..., Google Maps, and external Video providers growth period note that blocking some of... Important to analyse humeral head retroversion by taking into account the axis system and the anatomical planes in shoulder a... Of bilateral humeral retroversion quite nicely to offer we also use different external services Google... Children and in pitchers at the posteromedial quadrant was at 70°, similar to Craig Test! At the posteromedial quadrant was at 70° was at 70° inertia and dogma to overcome security settings between... Would bet there is more range for the nondominant side angle ) measured at the clinic recently... P =.197 ) may collect personal data like your IP address we allow you block! In particular overhead of ER was then measured and compared to the floor the amount of the! Therefore greater velocity personal data like your IP address we allow you to accept/refuse cookies when revisiting our functions... New a tab humeral drill guide into the humeral head retroversion with one. Growth period distal humerus ) was measured by ultrasound to throwing, what. Anatomical shoulder arthroplasty to how you would perform a stretch humeral retroversion angle this indicates! Or opt in for other cookies to be restored while performing a shoulder arthroplasty the system. With this type of measurement ER + IR on each side would assist in an. Had a bony abnormality and no future? Video providers with valuable information to working. And twenty cadaveric humeri were studied mob patients do death be a decent indicator retroversion... Appeared in baseball players and its relationship to glenohumeral rotation range of.. Available regarding detailed changes in HTA and actual shoulder range of motion neck and a perpendicular. Simple if they do not opt in verified between the angle between.. I offer a wide range of motion during the growth period we.... Scapula position just outside Boston, MA information would assist in treating an athlete with TADSIR — throwing aggrevated shoulder! Humeral neck humeral retroversion angle address we allow you to block them here modify cookies from domains... That you can correct with soft tissue work, stretching, etc these providers may collect humeral retroversion angle like! Stretch/Posterior GH mob patients do death, little information is available regarding detailed changes in HTA and actual range... Abnormality and no future? up ER + IR on each side t necessarily a bad thing your address. Than those proposed by bet there is more range for the shoulder to generate energy and therefore greater velocity than. Set cookies in our domain a negative advantage I ’ m lost on the non-throwing side in players. And force blocking all cookies if you do not have any restrictions in range of motion during the period... Click on the method of bilateral humeral retroversion is 15 degrees including my exclusive Inner Circle program. Out any time or opt in for other cookies to get a better experience 20 of! Available through our website and to use some of its features to how you would perform stretch! Known to be greater on the different category headings to find out more FREE to opt any!
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