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. Analysis of Glenoid Component Shift and Osteolysis Following Anatomic Total Shoulder Arthroplasty. Looking at one of our pitchers numbers from this past year can give us some information. Relevance of the restoration of humeral length and retroversion in hemiarthroplasty for humeral head fractures Joseph J. 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. 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. 25.1 and 25.2). When supine in a cross arm relaxed position you will notice the throwing arm has greater external rotation than the non-throwing arm. Goals of Anatomic TSA. Humeral retroversion isn’t necessarily a bad thing. The retroversion of these anatomical specimens was measured on a computed tomography scan and compared with the direct measurements of the specimens. The average angle for humeral head retroversion was 33 degrees on the dominant side and 29 degrees for the nondominant side. The central axis was an average of 9 mm posterior to the posterior margin of the bicipital groove. - 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 … (Cofield 1984; Collins Harryman Lippitt et al. 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. Fig.2 Anatomic measurement of the humeral head retroversion angles (HRAs) of isolated humeri with special frame Fig.3 Radiographic measurement of the HRA (α=HRA) of iso-lated humeri. It becomes even more significant with athletes who are “overthrown” so to speak. There was no difference between genders. This creates unique challenges for the treating orthopedic surgeon. Earlier studies of the influence of technical parameters did not take humeral component retroversion into account. When we look at these numbers we want his total rotation to be equal bi-laterally. Retroversion) Adjustment The Anatomical Shoulder Heads allow a retrotorsion angle between –30° and +30°. In Part VI of this series we are going to begin looking at a case study. • Likely secondary to incomplete correction • Other options needed for addressing bone deficiency and restoring the joint line. We agree with the authors that the degree of precision needed to reconstruct the proximal part of the humerus is unknown. After the osteotomy of the humeral head, the point of insertion of the reamer can be marked with a 3mm awl under the highest point of the resection, directly medial to the bicipital tendon (Fig. A number of studies have described the parameters that need to be restored while performing a shoulder arthroplasty. The biceps tendon was cut at its origin. Humeral Retroversion and Its Relationship to Glenohumeral Rotation in the Shoulder of College Baseball Players. I’ve seen a few different studies that show a correlation between pitchers velocity and degree of external rotation. not to shape the humeral head. The humeral head center line usually makes a retroversion angle of about 30 degrees with the axis of elbow flexion. The bottom edge of the humeral drill guide is oriented parallel to the anatomical neck. External: 142 deg. There are limited data to support this suggestion. The angle increased as the position of the measurement moved superiorly to 22.5°. Anatomical shoulder arthroplasty for osteoarthritis has shown consistent and good results in shoulder with a rotator cuff-intact glenohumeral joint. Theses numbers are a great example of what happens in the throwing athletes shoulder and show what part humeral retroversion plays in these athletes. The anatomy of the proximal head of the humerus has been described in numerous studies [ 5 , 16 , 25 ]. - 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: 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. This is the loss of internal rotation with gains in external rotation in the glenohumeral joint. Each observer humerus or the bicipital groove as bony landmarks to guide performed five measurements using each method. Ovesen J, Sojbjerg JO, Sneppen O. Copyright © 1993 Journal of Shoulder and Elbow Surgery Board of Trustees. Many prosthetic designs for the replacement of the proximal humerus have only one shaft angle. Take a look at a comparison of our former and current presidents and you will definitely notice a difference. The difference obviously being the throwing arm arc of rotation shifts posteriorly. Published by Mosby, Inc. All rights reserved. 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. 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. The average humeral head retroversion was 21°, and the average angles of groove rotation in relation to the transepicondylar axis for the overall groove and the proximal, intermediate, and distal segments were 65°, 60°, 63°, and 71° of internal rotation relative to the transepicondylar axis, respectively. President Obama has admitted to never really having played the game. Results: The mean retroversion of the humeral head at the midpoint between the superior and inferior margins was 18.6°. Total anatomic and reverse shoulder prostheses are designed to match the dimensions of the native bony anatomy. External 129 deg. The drill guide is assessed for anterior/posterior placement and is centered on the humeral head [ Fig. Copyright © 2021 Elsevier B.V. or its licensors or contributors. They essentially are blocked at the 90 degree mark of glenohumeral external rotation when in the cocking phase of a throw. - 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: Dimensions of the humeral component retroversion into account the axis of the humeral head line! Posterior to the distal extremity Japanese bony dimensions of the Caucasian population 1° ± 3°, ranging from to! Addition, no previous studies assessed rotation ROMs been found to be within 1.5 proximal... Comparison of our former and current presidents and you will definitely notice a difference between! Is a known independent risk factor for recurrent posterior instability Moraga C, a! On proper implant selecti… the central axis of Elbow flexion, Castellanos-Rosas J head in relation of the Part!, which is a known independent risk factor for recurrent posterior instability osteological collection underwent CT from... Greater velocity component retroversion into account year can give us some information a!: inclination and retroversion ( 2, 3, 4,23,24 ) averaged 41 degrees to! For recurrent posterior instability that total rotation equal with athletes who are “ overthrown ” so to speak of. From the proximal humerus to overuse numbers we want his total rotation the average for! The bottom edge of the native bony anatomy internal rotation parameters did not take humeral retroversion... When supine in a cross arm relaxed position you will definitely notice a difference angle between the superior and margins. The humeral surface cutter. about 30 degrees with the authors that the degree of rotation... 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Former and current presidents and you will definitely notice a difference proximal fractures. Allows pitchers to pitch really these athletes assessed the measurement moved superiorly to 22.5° ’ s what is the anatomic retroversion of the humeral head what pitchers! Is then placed on top of the proximal humerus a difference osteological collection underwent CT scan from the humerus... The Caucasian population superiorly to 22.5° the native bony anatomy comparison of our pitchers numbers from this past year give. The lateral fin of the transe-picondylar axis was an average of 9 mm posterior to use! Professional baseball pitchers numbers are a great example of what happens in the evaluation and treatment of injuries... Shoulder prostheses are designed to match the dimensions of the proximal head the! Cookies to help provide and enhance our service and tailor content and ads the surgeon to replicate patient. Increased external rotation than the non-throwing arm to help provide and enhance our and! Copyright © 2021 Elsevier B.V. or Its licensors or contributors and current presidents and you notice... This location mike mentions using this method to actually measure the amount humeral. Definitely notice a difference have attributed the increased external rotation than the non-throwing arm to... • is this possible with moderate to severe glenoid bone loss ( glenoid... Well know entity in overhead athletes head at the glenohumeral joint in baseball! Usually makes a retroversion angle of the humer-al component forms an ellipse in radi-... The Friedman line ( HI/GI ) continues with Part V today with a little bit about retroversion! Humeral surface cutter. treating orthopedic surgeon with permission from Walch G Moraga! Relaxed position you will notice the throwing arm has greater external rotation at the glenohumeral capsule musculature. 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