For verification purposes, the results of this study were found to be within 1.5% However, better glenohumeral apposition can be obtained by inserting the humeral head component in the premorbid degree of … We already know that his right arm ER will shift further back and along with that shift he will lose IR. humeral head prosthesis. PSS, range of motion, humeral head centering, and glenoid version were significantly improved among all patients (p < 0.0001). In this example we see that total rotation is virtually equal, which is a good thing. Rotation ROM should be improved … In addition, no previous studies assessed rotation ROMs. External 129 deg. Goals of Anatomic TSA. The consensus as of late seems that humeral retroversion is more strongly related to adaptive changes in proximal humeral anatomy than to changes in the soft tissues. The purpose was to study the anatomy of the humeral head, more specifically the retroversion of the humeral head and the orientation of the intertubercular sulcus, using CT scan, and to make correlations between those two entities of the proximal humerus. This is the loss of internal rotation with gains in external rotation in the glenohumeral joint. • Significantly higher preoperative retroversion, posterior humeral head subluxation in loose glenoids. The retroversion angle of humeral head is high - ly variable among individuals (-8° to +74°), and there has been many controversies on how to determine retroversion angle of humeral head during total shoulder arthroplasty [11-16], the correlation between position of intertubercular sulcus and torsion angles and the scientifical- ness and rationality of determining torsion angles using intertubercular sulcus as anatomi … Humeral head replacement was carried out based on two arbitrarily fixed angles: inclination and retroversion (2, 3, 4,23,24). More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. 1991; Figgie Inglis Goldberg et al. Take a look at a comparison of our former and current presidents and you will definitely notice a difference. Patients with persistent posterior subluxation of the humeral head postoperatively had worse preoperative fatty infiltration of the teres minor and greater postoperative component retroversion (p < 0.05). Virtually every throwing athlete that you come across will have excessive external rotation on … When we look at these numbers we want his total rotation to be equal bi-laterally. Relevance of the restoration of humeral length and retroversion in hemiarthroplasty for humeral head fractures Joseph J. The Anatomic Stemless Humeral Prosthesis Nael Hawi and Peter Habermeyer nI troduction Since 1951, early applications of shoulder arthro - plasty underwent a complete transition in the development of humeral and glenoidal compo-nents, towards a more anatomical, modular, revisable, or convertible design (Figs. Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. Virtually every throwing athlete that you come across will have excessive external rotation on the dominant side with a decreased internal rotation. 16, 17 However, using the bicipital groove at the surgical neck as an anatomic landmark may create excessive retroversion of the humeral head. 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 … 25.1 and 25.2). President Bush played baseball as a kid. The biceps tendon was cut at its origin. head subluxation is the percentage of humeral head posterior to the Friedman line (HI/GI). - average humeral head thickness was 19 mm; - humeral head inclination averaged 41 deg but was less variable than previously described, with 95 % of sample within range of 35 to 46 deg; - proximal humeral retroversion was variable and averaged 19 degrees; - average diameter in males was 48 +/- 4 mm, and in females 44 +/- 4 mm; - reference: Denard & Walch, JSES 2013 Walch et al, JSES 2012 What is the Consequence of Incomplete Correction? We therefore determined normal humeral head retroversion and assessed the measurement methods. Mike Reinold, Head ATC for the Boston Red-Sox, has talked about being able to see the degree of humeral retroversion in a pitcher. The drill guide is assessed for anterior/posterior placement and is centered on the humeral head [ Fig. vided into four anatomic areas: hu-meral head, greater tuberosity, lesser tuberosity, and surgical neck.5,6 The average humeral neck-shaft angle measures approximately 140°.7 Hu-meral head version is quite variable depending on which anatomic land-marks are used.8,9 Historically, 30° of humeral head retroversion has been considered normal. Glenoid retroversion and humeral head subluxation have been suggested to lead to inferior outcomes after total shoulder arthroplasty (TSA). The retroversion of these anatomical specimens was measured on a computed tomography scan and compared with the direct measurements of the specimens. Reprinted with permission from Walch G, Moraga C, Young A, Castellanos-Rosas J. Average glenoid retroversion was 1° ± 3°, ranging from −9° to 13°. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Anatomic determination of humeral head retroversion: The relationship of the central axis of the humeral head to the bicipital groove. The humeral drill guide is then placed on top of the humeral head. External: 142 deg. Glenoid retroversion is a known independent risk factor for recurrent posterior instability. 11 ]. Anatomic Augmented Glenoid Implants for the Management of the B2 Glenoid Lisa GM Friedman, MD, MA1 and Grant E Garrigues, MD1 Abstract The B2 glenoid is defined by Walch et al. Average glenoid retroversion was 1° ± 3°, ranging from −9° to 13°. scapula by posteriorly shifting the humeral head by 11 mm (until greater tuberosity impingement with acromion), su-periorly shifting the humerus by 1.5 mm, and then medially translating the humeral head by 7.0 mm, 8.5 mm, and 10.0 mm into the scapula, respectively. The relationship of the central axis of the humeral head to the bicipital groove was studied in 18 fresh cadaver specimens. Humeral Head Resection Humeral retroversion is a well know entity in overhead athletes. The bottom edge of the humeral drill guide is oriented parallel to the anatomical neck. It becomes even more significant with athletes who are “overthrown” so to speak. Keywords: Bicipital groove, bicipital groove orientation, retroversion angle of the humeral head, correlation coef-ficient Introduction Humeral head retroversion angle (RA) affects the mobility and stability of the shoulder. Copyright © 1993 Journal of Shoulder and Elbow Surgery Board of Trustees. There was no difference between genders. Such overuse has been postulated as resulting in a contracture of the posterior shoulder capsule and stretching of the anterior shoulder capsule, leading to a tendency toward anterior glenohumeral subluxation. The angle between the humeral neck and a line perpendicular to the axis of the forearm averaged 41 degrees. An instrument is designed for the anatomic angle of retroversion of the humeral component for nonconstrained shoulder joint arthroplasty. In one study of professional baseball players tested were noted to have 141° of external rotation on their dominant side and 132° on their non-dominant side. retroversion, humeral head medial offset, humeral head pos-terior offset, humeral head diameter, glenoid height, glenoid width, and the glenoid height to width ratio. The anatomic (primary) shoulder allows the surgeon to replicate a patient’s unique anatomy by independently adjusting parameters in situ. • Likely secondary to incomplete correction • Other options needed for addressing bone deficiency and restoring the joint line. as a glenoid that is biconcave with posterior erosion accompanied by posterior humeral head subluxation. (Cofield 1984; Collins Harryman Lippitt et al. The Anatomic Stemless Humeral Prosthesis Nael Hawi and Peter Habermeyer nI troduction Since 1951, early applications of shoulder arthro - plasty underwent a complete transition in the development of humeral and glenoidal compo-nents, towards a more anatomical, modular, revisable, or convertible design (Figs. The central axis was an average of 9 mm posterior to the posterior margin of the bicipital groove. Results: The mean retroversion of the humeral head at the midpoint between the superior and inferior margins was 18.6°. Knowing the width and length of the ellipse as well as the inclination angle in a plain radiograph, the exact inclination angle can be determined using the equation reported below. 365. the arm brings the subscapularis into the eld and farther from . the axillar y ner ve. The values of humeral head retroversion were widely distributed from −2° to 60°, with an average of 26° ± 11°. When supine in a cross arm relaxed position you will notice the throwing arm has greater external rotation than the non-throwing arm. Total Rotation: 190. I’m referring to the superstar 12-year-old that pitches year round on 3 different select teams, a little league team, showcase camps, etc. “This has been shown in children and in pitchers at the college and professional levels. Others have attributed the increased external rotation to overuse. With increasing angles of retroversion, the base of the humer-al component forms an ellipse in plain radi- ographs. the retroversion of the humeral head by CT scan, we pro-pose new, practically relevant measures such as the ori-entation of the intertubercular sulcus, using an easy method. Some have described these changes in the soft tissues about the glenohumeral joint as “relative laxity.”  Essentially, these changes represent an attempt by the shoulder to attain a balance between the flexibility needed to allow for greater external rotation and the stability needed to counter the anterior shear forces across the joint during the process of pitching.”. When compared with the non-dominant arm we hope to see total rotation equal. Sixty dry adult humeri from an osteological collection underwent CT scan from the proximal to the distal extremity. For verification purposes, the results of this study were found to be within 1.5% to 14.3% of other anatomic studies published in the literature. To The Editor: We read with interest the paper "Determining Humeral Retroversion with Computed Tomography" (2002;84:1753-62) by Hernigou et al. Many prosthetic designs for the replacement of the proximal humerus have only one shaft angle. With the anatomic specimen positioned with increasing external and internal rotation, the greatest difference was 2° compared with the values noted in the neutral position , which is not significant (P = .911). This creates unique challenges for the treating orthopedic surgeon. 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. The retroversion of the humeral head and the orientation of the intertubercular sulcus are two bony features of the proximal humerus that may be … not to shape the humeral head. Ovesen J, Sojbjerg JO, Sneppen O. Copyright © 2021 Elsevier B.V. or its licensors or contributors. 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. Bicipital groove location has been used as a reference for humeral stem orientation in total shoulder arthroplasty to recreate humeral head retroversion. Theses numbers are a great example of what happens in the throwing athletes shoulder and show what part humeral retroversion plays in these athletes. Placing the lateral fin of the prosthesis either 9 mm or 12 mm posterior to the bicipital groove at the anatomic neck has been recommended. When you watch people who can’t throw, or “throw like a girl,” it’s likely due to the fact that, they never developed that motor pattern as a youngster, or more likely that they didn’t develop the humeral retroversion to allow them to lay their arm back into external rotation. In relation of the bicipital groove location has been used as a glenoid that biconcave. Series continues with Part V today with a decreased internal rotation with gains in external rotation ;. ” so to speak 2021 Elsevier B.V. or Its licensors or contributors 4,23,24 ) a! Implant selecti… the central axis of Elbow flexion the throwing arm has greater external rotation is due changes. Results depend on proper implant selecti… the central axis of Elbow flexion 29 degrees the! Selecti… the central axis of Elbow flexion investigators have postulated that this high level external! Retroversion ( 2, 3, 4,23,24 ) the difference obviously being the throwing arm has greater external rotation the... 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