An instrument is designed for the anatomic angle of retroversion of the humeral component for nonconstrained shoulder joint arthroplasty. Conclusion. Ovesen J, Sojbjerg JO, Sneppen O. The mean retroversion angle of the humeral head in relation of the transe-picondylar axis was 12.3 degree. 365. the arm brings the subscapularis into the eld and farther from . Virtually every throwing athlete that you come across will have excessive external rotation on … This creates unique challenges for the treating orthopedic surgeon. 60 Convertible Humeral Stem: Anatomic to R everse Arthroplasty. More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. In shoulder arthroplasty, the humeral head articular surface is usually deformed, and sometimes, more useful anatomic landmarks of the humeral head are needed for guiding anatomic recreation of retroversion, such as the greater tuberosity posterior margin, bicipital groove center, proximal metaphysis, or the distal part of an osteoarthritic humeral head. Finally, we searched for correlations between those two entities of the proximal humerus. 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. 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. C HRISTOFORAKIS , George M. K ONTAKIS , Pavlos G. K ATONIS , Thomas M ARIS , This fixed inclination limits the potential for the surgeon to reproduce the original anatomy. The anatomic (primary) shoulder allows the surgeon to replicate a patient’s unique anatomy by independently adjusting parameters in situ. 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 … The biceps tendon was cut at its origin. Osseous adaptation and range of motion at the glenohumeral joint in professional baseball pitchers. 25.1 and 25.2). 9). The retroversion of these anatomical specimens was measured on a computed tomography scan and compared with the direct measurements of the specimens. 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). Humeral head retroversion is gen-erally defined with respect to the plane of the humeral head articular surface proximally; distally, however, the refer- Earlier studies of the influence of technical parameters did not take humeral component retroversion into account. Our anatomic study in a large number of cadavers involved a detailed and reproducible experimental protocol. 1988; Friedman Thornhill Thomas et al. The central axis was an average of 9 mm posterior to the posterior margin of the bicipital groove. The bottom edge of the humeral drill guide is oriented parallel to the anatomical neck. The values of humeral head retroversion were widely distributed from −2° to 60°, with an average of 26° ± 11°. In this example we see that total rotation is virtually equal, which is a good thing. Reprinted with permission from Walch G, Moraga C, Young A, Castellanos-Rosas J. Postoperative 3D CT imaging analysis demonstrates that shift of a polyethylene glenoid component commonly occurs following anatomic TSA, with increased inclination the most common direction of shift. Total Rotation: 189, Left • Significantly higher preoperative retroversion, posterior humeral head subluxation in loose glenoids. PSS, range of motion, humeral head centering, and glenoid version were significantly improved among all patients (p < 0.0001). 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. Humeral head replacement was carried out based on two arbitrarily fixed angles: inclination and retroversion (2, 3, 4,23,24). Internal: 47 deg. The anatomy of the proximal head of the humerus has been described in numerous studies [ 5 , 16 , 25 ]. If you missed the previous sections you can find them below. By continuing you agree to the use of cookies. 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. 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. The central axis was an average of 9 mm posterior to the posterior margin of the bicipital groove. Bicipital groove location has been used as a reference for humeral stem orientation in total shoulder arthroplasty to recreate humeral head retroversion. 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. 1991; Figgie Inglis Goldberg et al. With increasing angles of retroversion, the base of the humer-al component forms an ellipse in plain radi- ographs. Results of anatomic noncon - strained prosthesis in primary osteoarthritis with biconcave glenoid. https://doi.org/10.1016/S1058-2746(09)80085-2. 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). With loads applied to the rotator cuff and deltoid, joint contact pressures and the force and energy required for posterior humeral head translation were measured. President Obama has admitted to never really having played the game. Humeral retroversion is a well know entity in overhead athletes. With greater retroversion of the humerus, there is the potential for more external rotation. There are two important steps in … They essentially are blocked at the 90 degree mark of glenohumeral external rotation when in the cocking phase of a throw. Knowledge of local anatomy is paramount in the evaluation and treatment of these injuries. This is the loss of internal rotation with gains in external rotation in the glenohumeral joint. However, better glenohumeral apposition can be obtained by inserting the humeral head component in the premorbid degree of … 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 humeral head center line usually makes a retroversion angle of about 30 degrees with the axis of elbow flexion. A humeral head cutting guide: instrument to secure correct humeral component retroversion in shoulder joint arthroplasty. The mean retroversion of the humeral head was 27° ± 10°. The glenoid cavity and the scapular neck were reamed from lateral to medial , leaving the glenoid circumference, the capsular attachment, and … Looking at one of our pitchers numbers from this past year can give us some information. 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. Our shoulder series continues with Part V today with a little bit about humeral retroversion in the overhead athlete. President Bush played baseball as a kid. Some believe it is soft tissue adaptations, other believe that it develops as changes to the bony anatomy when youth athletes are involved in throwing sports. Shoulder Mobility and the Fist to Fist PART I, Shoulder Series and the Sleeper – Part II, Internal Impingement of the Shoulder – PART IV. The relationship of the central axis of the humeral head to the bicipital groove was studied in 18 fresh cadaver specimens. The Pearson correlation coefficient between the retroversion of the humeral head and the ITS orientation was -0.37. To The Editor: We read with interest the paper "Determining Humeral Retroversion with Computed Tomography" (2002;84:1753-62) by Hernigou et al. When supine in a cross arm relaxed position you will notice the throwing arm has greater external rotation than the non-throwing arm. - 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: Humeral head retroversion is not well described with the literature controversial regarding accuracy of measurement methods and ranges of normal values. The anatomical problem associated with the insertion of a humeral prosthesis is the definition of the humeral head retroversion relative to the … I’ve seen a few different studies that show a correlation between pitchers velocity and degree of external rotation. 1989; Hawkins Bell and Jallay 1989; Neer 1990; Neer and Kirby 1982; Pearl and Lippitt 1993; Roper Paterson and Day 1990; Weiss Adams Moore et al. 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. In the same way, resecting the humeral head at a fixed retroversion of 30 to 40 degrees (in relation to the forearm) in an individual who has only 5 to 10 degrees of retroversion can lead to posterior cuff damage and also will alter the kinematics. When compared with the non-dominant arm we hope to see total rotation equal. 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. Relevance of the restoration of humeral length and retroversion in hemiarthroplasty for humeral head fractures Joseph J. External: 142 deg. We traobserver variation in the measurements was less than 3 hypothesized: (1) normal values of humeral head retro- for each measurement method. Maximum external rotation at the shoulder during pitching has been reported to be as much as 160° to 178°. 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. not to shape the humeral head. Copyright © 1993 Journal of Shoulder and Elbow Surgery Board of Trustees. The humeral head was resected at the anatomic neck and replaced with an anatomically inserted prosthetic humeral component of physiologic size (Anatomical Shoulder; Zimmer GmbH, Winterthur, Switzerland). - proximal humeral retroversion was variable and averaged 19 degrees; ... - modular humeral components allow for more anatomic replication of humeral head component - axis of humeral shaft is identified and prepared anatomically - humeral shaft axis is generally offset anterior and lateral to humeral head … Regardless, our goal is to equalize total rotation. In the anatomic position the humeral head is retroverted 30to 401, 3 During humeral head replacement in shoulders without special problems, the humeral head component should be implanted to recreate this degree of retroversion. It’s actually what allows pitchers to pitch really. We already know that his right arm ER will shift further back and along with that shift he will lose IR. Throwing athletes almost always present themselves with some degree of humeral retroversion. 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. Some investigators have postulated that this high level of external rotation is due to changes in the glenohumeral capsule and musculature caused by pitching. Internal 61 deg. There are several different theories as to how exactly this occurs. 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. There are limited data to support this suggestion. Humeral retroversion is generally defined as the angular difference between the orientation of the proximal humeral head and the axis of the elbow at the distal humerus. 16, 17 However, using the bicipital groove at the surgical neck as an anatomic landmark may create excessive retroversion of the humeral head. For verification purposes, the results of this study were found to be within 1.5% Correct RA influences the position of … We agree with the authors that the degree of precision needed to reconstruct the proximal part of the humerus is unknown. the definition of humeral head retroversion, different methods of measurement, ranges of normal values, and accuracy of anatomic landmarks to guide determination of anatomic retroversion. Sixty dry adult humeri from an osteological collection underwent CT scan from the proximal to the distal extremity. When we look at these numbers we want his total rotation to be equal bi-laterally. Total anatomic and reverse shoulder prostheses are designed to match the dimensions of the native bony anatomy. At any rate these adaptive changes usually happen when children are heavily involved in throwing sports at a young age. The angle between the humeral neck and a line perpendicular to the axis of the forearm averaged 41 degrees. Each observer humerus or the bicipital groove as bony landmarks to guide performed five measurements using each method. Results: The mean retroversion of the humeral head at the midpoint between the superior and inferior margins was 18.6°. Goals of Anatomic TSA. In reproduction of humeral head retroversion during humeral head replacement surgery, the lateral fin of the prosthesis should be placed at this location. In reproduction of humeral head retroversion during humeral head replacement surgery, the lateral fin of the prosthesis should be placed at this location. Average glenoid retroversion was 1° ± 3°, ranging from −9° to 13°. External 129 deg. Published by Mosby, Inc. All rights reserved. Mike Reinold, Head ATC for the Boston Red-Sox, has talked about being able to see the degree of humeral retroversion in a pitcher. Many prosthetic designs for the replacement of the proximal humerus have only one shaft angle. 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. • Centering of the humeral head • Is this possible with moderate to severe glenoid bone loss (B2 glenoid)? Information regarding humeral head vascularity, fracture patterns, bone quality, and overall geometry have direct implications for nonoperative treatment, internal fixation, and hemiarthroplasty. It becomes even more significant with athletes who are “overthrown” so to speak. 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