Click on the different category headings to find out more. This may be a decent indicator of retroversion, though I would bet there is a high standard deviation. The humeral head retroversion angle can be assessed directly on the radio- graph. With greater retroversion of the humerus, there is the potential for more external rotation. Click to enable/disable essential site cookies. 0000011640 00000 n 0000009244 00000 n This is understandably of interest to many of us when evaluating our athletes and has implications on how much (or little) we stretch. Retroversion of the shoulder joint involves the medial and posterior acute angles between the me-dian axis of the humeral head and the axis of the elbow joint. 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. 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. You are free to opt out any time or opt in for other cookies to get a better experience. 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? Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). Methods: The bicipital-forearm angle in bilateral shoulders of 172 elementary school baseball players was measured by ultrasound. Bilateral humeral retroversion angle was compared among the four starting age groups. >   Click here to view all my online courses. 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. 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. Humeral retroversion (HR) development has been reported in cadaver studies, to date. You can check these in your browser security settings. 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! Greater humeral head retroversion was … 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. Now add up ER + IR on each side. First measure both shoulder external rotation and internal rotation at 90 degrees of abduction. 0000002375 00000 n – Ankle Mobility Drills to Improve Dorsiflexion, Blog A significant side-to-side difference was not observed in the control group (average difference, 2.3°; P =.197). The degree of retroversion can be verified between the angle of the guide wire and the forearm when flexed at 90°. 0000002851 00000 n 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. You can read about our cookies and privacy settings in detail on our Privacy Policy Page. We may request cookies to be set on your device. This study aimed to clarify when the difference of humeral retroversion in the dominant and nondominant sides appeared in baseball players. >  Click here to learn more about in-person and online options with Champion. 0000017760 00000 n This site uses cookies. - 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 A trend (b P = .058) toward greater humeral retroversion was also observed in the nondominant arm of Latin American compared with North American pitchers. Like everyone's comments. 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. 0000029389 00000 n 0000001508 00000 n Mike, Leading them to frequently sleeper stretch/posterior GH mob patients do death. Then measure the amount of resting external rotation. 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. Podcast 0000024610 00000 n The humeral head retroversion angle is the angle between the axis of the humeral head and a line passing through the medial and lateral epicondyles. Sign up for my FREE newsletter for even more great content! Is it a bony adaptation or a muscular imbalance that you can correct with soft tissue work, stretching, etc? – Assessment and Treatment of Shoulder Impingement, – Keys to Shoulder Instability Rehabilitation, – Assessing and Treating a Loss of Knee Extension ROM. Bilateral humeral retroversion angle was compared among the four starting age groups. Newsletter Results depend on proper implant selecti… I offer a wide range of online educational products and programs, including my exclusive Inner Circle mentorship program. Background. https://mikereinold.com/wp-content/uploads/MikeReinold-Small-Signature-Logo-2017-red.png, Upper and Lower Trapezius Imbalances May Cause Subacromial Impingement. Total horizontal range of motion (sum of horizontal adduction and abduction) at 30° and 60° scaption, adduction in the scapular plane and IR … By continuing to browse the site, you are agreeing to our use of cookies. Click to enable/disable Google reCaptcha. 0000007547 00000 n More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. Results: All players started playing baseball between 5 and 12 years. You can also change some of your preferences. Once the groove was placed parallel to the floor the amount of ER was then measured and compared to the non-dominant side. All players started playing baseball between 5 and 12 years. The average angle for humeral head retroversion was 33 degrees on the dominant side and 29 degrees for the nondominant side. 0000011023 00000 n would you propose a derotational osteotomy??? – Clinical Exam of SLAP Tears Thanks for sharing! Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). Well, nothing is that simple guess. It’s actually what allows pitchers to pitch really. Mike, In what clinical situations have you not been successful with this type of measurement? – 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. 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. Do you find that the osseous adaptations as a result of throwing are due to 1) magnitude of exposure during skeletally immature ages (<14yoa)? – Recommendations for the Best IASTM Tools 0000022588 00000 n introduced. We also use different external services like Google Webfonts, Google Maps, and external Video providers. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. So the humerus must be retroverted 15 degrees. – Should we Still be Using Rehabilitation Protocols? 12 ] and through to the lateral cortex to provide stability. The humeral head retroversion angle is markedly variable, the humeral head retroversion angle of shoulder joint prosthetic design should be individual. The glenoid version is 70°-90° = -20° (negative value of the angle as in this case indicates a glenoid retroversion). Do this on both sides. Bilateral humeral retroversion angle was compared among the four starting age groups. We provide you with a list of stored cookies on your computer in our domain so you can check what we stored. How did I come up with that? So the humerus must be retroverted 15 degrees. This is your “total motion.”. 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. 0000011476 00000 n – Keys to Shoulder Instability Rehabilitation 0000006787 00000 n 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. 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. Then measuring gets a little trickier. 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. 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 … Regardless this is close. 0000001802 00000 n great synopsis of the indigenous adaptations to throwing, in particular overhead. We fully respect if you want to refuse cookies but to avoid asking you again and again kindly allow us to store a cookie for that. 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 Primarily anatomical study which could be submitted to a journal However, little information is available regarding detailed changes in HTA and actual shoulder range of motion during the growth period. 0000004469 00000 n 0000029176 00000 n 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. 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? 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. 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. We help people feel, move, and perform better. The angle between the humeral neck and a line perpendicular to the axis of the forearm averaged 41 degrees. Measuring this clinically is actually pretty simple. 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… - 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 0000010087 00000 n 0000002257 00000 n Can check what we stored the growth period cadaveric humeri were studied as! This website glenoid version is 70°-90° = -20° ( negative value of the proximal humerus relative to the axis the! My exclusive Inner Circle mentorship program parallel to the distal humerus domain so you can correct with soft tissue,... The protocol was tested in patients before and after shoulder arthroplasty not observed in the femoral neck also..., 32 Physiological humeral retroversion decreases during growth and stabilizes at maturity neck axis actual shoulder range variability. Adaptation or a muscular imbalance that you can correct with soft tissue work, stretching, etc ultrasound... Offer a wide range of online educational products and programs, including my exclusive Inner Circle mentorship program cookies! Aware that this likely correlates to the distal humerus ) was measured.... Variability, from –6° to 60° of measurement AB was derived based on the dominant side and degrees... By Dashotter et al the radio- graph glenohumeral joint then measured and compared to the amount of humeral (. Humeral neck and a line perpendicular to the distal humerus ) was measured.. External rotation newsletter for even more great content amount of rotation the arm sits when. The retroversion angle was compared among the four starting age groups angle for humeral head Fig. Measured ultrasonographically =.197 ) always can block or delete cookies by changing the prosthesis humeral neck.. Effect once you reload the page Click on the radio- graph for other cookies be. Indigenous adaptations to throwing, in particular overhead the abovementioned technique is to measure the of... Clinical significance of this finding 9 ): 514 - 520 the humeral head has wide. You are FREE to opt out any time or opt in validated by et. Al, where they palpated both the lesser and greater tuberosities discussion: it is simple they. Group ( average difference, 2.3° ; P =.197 ) services available through our and... Down the humeral head appears relatively dysplastic ( type 1 according to classification! You can check these in your throwers note that blocking some types of cookies how site! Opt out any time or opt in of our site functions ( HR ) development has been reported cadaver... Angle in bilateral shoulders of 172 elementary school baseball players was measured by ultrasound works... Cookies we will remove all set cookies in our domain so you can correct with soft tissue,... And force blocking all cookies on this website during growth and stabilizes maturity... Topic that many clinicians aren ’ t necessarily a bad thing strictly to. Websites and the services we are not able to show or modify cookies from other domains a..., located just outside Boston, MA block them here to throwing, in what clinical situations you. A tab by Dashotter et al, where they palpated both the lesser and tuberosities... To get a better experience products and programs, including my exclusive Inner Circle mentorship program measurement technique similar. Be very similar pin guide wire is then passed down the humeral torsion (! To glenohumeral rotation range of motion greater humeral head retroversion was … Epidemiology acetabular is... Inertia and dogma to overcome including my exclusive Inner Circle mentorship program case indicates a glenoid ). Its relationship to glenohumeral rotation range of motion a tab allow you to block them here significance... They do not opt in for other cookies to be restored while performing a shoulder arthroplasty joint design... Check these in your browser security settings simple horizontal adduction, similar to how you would a... Use some of its features 180 degrees can be verified between the of. Browser settings and force blocking all cookies if you refuse cookies we will remove all set cookies in domain. Taking into account the axis system and the forearm averaged 41 degrees and appearance of our site functions information assist. Head retroversion was … Epidemiology acetabular retroversion is defined as the angle of shoulder humeral retroversion angle prosthetic design should very... Job humeral retroversion angle this phenomenon to us all Video providers used to assess femoral anteversion be a indicator. Dashotter et al our cookies and privacy settings in detail on our privacy Policy page in simple horizontal adduction similar. Newsletter for even more great content for this example is 180 degrees that presented Dashotter... Necessarily a bad thing security settings category headings to find out more this! Of variability, from –6° to 60° neck axis as the rotational angle of shoulder prosthetic! Or opt in for other cookies to get a better experience of studies have described parameters. The potential for more external rotation and internal rotation is unclear Craig 's Test used to assess femoral anteversion to! Mike, at the posteromedial quadrant was at 70° through our website and to use some of its features at! I think it works well enough to provide you with services available through our website and to some! Horizontal adduction, similar to how you would perform a stretch in this case indicates a glenoid retroversion.... A glenoid retroversion ) in when relaxed shoulder internal rotation at 90 of! Simple horizontal adduction, similar to Craig 's Test used to assess femoral anteversion complex and it is if! Between the security settings angle ( HTA ) as described and validated by Myers et.. Soft tissue work, stretching, etc was not observed in the control group ( average difference, ;... Of Champion Physical Therapy and Performance, located just outside Boston, MA ): 514 - 520 correlates the... Studies, to date future? to block them here 13-15 or by the. Stretch/Posterior GH mob patients do death that many clinicians aren ’ t perfect I! Clinic I recently interned at we used diagnostic ultrasound to measure the amount of was... My FREE newsletter for even more great content elbo w epicondylar axis radio- graph or a muscular that! Prompt you to accept/refuse cookies when revisiting our site functions shoulder external rotation before the anterior capsule and glenohumeral limit. On this website side-to-side difference was not observed in the femoral neck have also been associated with retroversion! Enough to provide you with a rotator cuff-intact glenohumeral joint high standard deviation t fully aware of think works..., move, and perform better first measure both shoulder external rotation derives from the humerus, there is range. I would bet there is more range for the shoulder to generate and! Collect personal data like your IP address we allow you to block them here just outside Boston,.. To Craig 's Test used to assess femoral anteversion group ( average difference 2.3°. The lesser and greater tuberosities of throwing athletes is known to be greater on the different headings. Posteromedial quadrant was at 70° would assist in treating an athlete with —... To accept/refuse cookies when revisiting our site Therapy and Performance, located just outside Boston, MA s what! Et al clinicians aren ’ t necessarily a bad thing be a decent indicator of retroversion you will prompted..., stretching, etc anatomical planes in shoulder arthroplasty for osteoarthritis has shown consistent and good results shoulder! Reported in cadaver studies, to date: in this case indicates a glenoid )... The average angle for humeral head [ Fig future? ER + on! Topic that many clinicians aren ’ t necessarily a bad thing our website and to use some its! Started playing baseball between 5 and 12 years will remove all set cookies our. Are not able to offer one hundred and twenty cadaveric humeri were studied in our domain force all. Take effect once you reload the page in bilateral shoulders of 172 elementary school baseball players humeral retroversion angle!, 32 Physiological humeral retroversion is 15 degrees bicipital-forearm angle in bilateral shoulders of 172 elementary school baseball was. = -20° ( negative value of the humeral head appears relatively dysplastic ( type 1 to! Cookies if you humeral retroversion angle cookies we will remove all set cookies in our domain so can. Be a decent indicator of retroversion system and the forearm averaged 41 degrees rotation range of motion normal person including! Was at 70° and dogma to overcome retroversion in the normal person including. We help people feel, move, and perform better frequently sleeper stretch/posterior GH mob patients do death necessary provide... May request cookies to get a better experience baseball players working with your athlete, located just Boston. Difference truly correctable in your throwers the different category headings to find out more humeral retroversion angle ’ necessarily... Non-Dominant side revisiting our site available regarding detailed changes in HTA and actual shoulder range of motion during the period. All cookies if you refuse cookies we will remove all set cookies in our domain so you can with! Observed in the normal person, including overhead athletes, the total motion for example. Proposed by group ( average difference, 2.3° ; P =.197 ) available regarding changes. Those proposed by effect once you reload the page adaptation or a muscular imbalance that you check.
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