0000003386 00000 n Thanks for sharing! Services 0000011476 00000 n Material and Methods Humeral head retroversion. Then measure the amount of resting external rotation. It isn’t perfect but I think it works well enough to provide you with valuable information to begin working with your athlete. other than profiling the athlete to a negative advantage i’m lost on 0000018043 00000 n Methods: The bicipital-forearm angle in bilateral shoulders of 172 elementary school baseball players was measured by ultrasound. 2007 ;37(9): 514 - 520 . As you can see in the photos, the dominant arm is resting in much more external rotation. A trend (b P = .058) toward greater humeral retroversion was also observed in the nondominant arm of Latin American compared with North American pitchers. 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. – The Best Self Myofascial Release Tools Background. 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. Bilateral humeral retroversion angle was compared among the four starting age groups. > Click here to view all my online courses. 28 0 obj <> endobj xref 28 41 0000000016 00000 n With greater retroversion of the humerus, there is the potential for more external rotation. There was no difference between genders. RESULTS: All players started playing baseball between 5 and 12 years. Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). 0000024610 00000 n This works well for all types of patients. found this method more precise than those proposed by. – 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. 0000029389 00000 n 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 … Please be aware that this might heavily reduce the functionality and appearance of our site. Mike,Interesting post…the question for me is the difference truly correctable in your throwers? the clinical significance of this finding. – Evaluating and Treating Injuries Good luck changing opinions on this one, there’s a lot of inertia and dogma to overcome. 0000002851 00000 n A K-wire or Steinman pin guide wire is then passed down the humeral drill guide into the humeral head [ Fig. how would this change treatment or prognosis? Bilateral humeral retroversion angle was compared among the four starting age groups. Primarily anatomical study which could be submitted to a journal Results: All players started playing baseball between 5 and 12 years. 0000029243 00000 n It is simple if they do not have any restrictions in range of motion. You always can block or delete cookies by changing your browser settings and force blocking all cookies on this website. 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…. So the humerus must be retroverted 15 degrees. 0000008946 00000 n Regardless this is close. A number of studies have described the parameters that need to be restored while performing a shoulder arthroplasty. 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. 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. 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… Courses You can assume that this likely correlates to the amount of retroversion. 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? Anatomical shoulder arthroplasty for osteoarthritis has shown consistent and good results in shoulder with a rotator cuff-intact glenohumeral joint. Is it a bony adaptation or a muscular imbalance that you can correct with soft tissue work, stretching, etc? 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. 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). Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion. But this will always prompt you to accept/refuse cookies when revisiting our site. 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. 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 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. Do you find that the osseous adaptations as a result of throwing are due to 1) magnitude of exposure during skeletally immature ages (<14yoa)? Generally, the retroversion angle of the humeral head is 26–30°; however, radiography has shown that changes in shoulder joint ROM by angle of retroversion would allow great-er external rotation before the anterior capsule and glenohumeral ligaments limit additional movement. – Assessment and Treatment of Shoulder Impingement, – Keys to Shoulder Instability Rehabilitation, – Assessing and Treating a Loss of Knee Extension ROM. 0000003275 00000 n – Optimizing and Enhancing Performance, – Assessment and Treatment of Shoulder Impingement Since these providers may collect personal data like your IP address we allow you to block them here. Due to security reasons we are not able to show or modify cookies from other domains. – Should we Still be Using Rehabilitation Protocols? 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. Let’s say that the total motion for this example is 180 degrees. Bilateral humeral retroversion angle was compared among the four starting age groups. Results depend on proper implant selecti… Check to enable permanent hiding of message bar and refuse all cookies if you do not opt in. Do this on both sides. 0000004469 00000 n Results. 0000001508 00000 n About. Mike, In what clinical situations have you not been successful with this type of measurement? Greater humeral head retroversion was … Otherwise you will be prompted again when opening a new browser window or new a tab. In this case, the glenoid-scapular angle (α angle) measured at the posteromedial quadrant was at 70°. Dominant arm: ER = 130 deg + IR 50 deg = 180 deg total motion, Nondominant arm: ER = 115 deg + IR 65 deg = 180 deg total motion. 0000002257 00000 n We. 0000001116 00000 n of clincial anatomy. – Clinical Exam of SLAP Tears – Keys to Shoulder Instability Rehabilitation Results. Humeral retroversion (HR) development has been reported in cadaver studies, to date. The angle between the humeral neck and a line perpendicular to the axis of the forearm averaged 41 degrees. This may be a decent indicator of retroversion, though I would bet there is a high standard deviation. 0000001844 00000 n 6, 10, 15, 16, 18, 32 Physiological humeral retroversion decreases during growth and stabilizes at maturity. 0000005240 00000 n 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. 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. 12,13 It was chosen over that presented by Dashotter et al, where they palpated both the lesser and greater tuberosities. 0000004494 00000 n The retroversion of these anatomical specimens was measured on a computed … Click on the different category headings to find out more. glenosphere 13-15 or by changing the prosthesis humeral neck angle. 0000029310 00000 n Humeral retroversion is defined as the rotational angle of the proximal humerus relative to the distal humerus. my latest article published in Sports Health. Epidemiology Acetabular retroversion is a common abnormality affecting 5 to 20% of the general population. 0000024715 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. Let me explain: In this scenario the amount of humeral retroversion is 15 degrees. Total horizontal range of motion (sum of horizontal adduction and abduction) at 30° and 60° scaption, adduction in the scapular plane and IR … Newsletter introduced. – Simple Thoracic Mobility Drills However, little information is available regarding detailed changes in HTA and actual shoulder range of motion during the growth period. You are free to opt out any time or opt in for other cookies to get a better experience. 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. All players started playing baseball between 5 and 12 years. You can check these in your browser security settings. Mike, More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. DISCUSSION: It is important to analyse humeral head retroversion by taking into account the axis system and the anatomical planes in shoulder arthroplasty. - 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 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. A significant side-to-side difference was not observed in the control group (average difference, 2.3°; P =.197). 3. 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. 0000030221 00000 n Click to enable/disable essential site cookies. Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). – Assessing and Treating a Loss of Knee Extension ROM If you refuse cookies we will remove all set cookies in our domain. Humeral retroversion is a well know entity in overhead athletes. 0000006787 00000 n Then measuring gets a little trickier. The humeral head retroversion angle is markedly variable, the humeral head retroversion angle of shoulder joint prosthetic design should be individual. humeral head axis and the elbo w epicondylar axis. 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. Used diagnostic ultrasound to measure the degree of retroversion can be assessed directly on the dominant nondominant! To generate energy and therefore greater velocity, etc profiling the athlete to a advantage! Perfect but I think it works well enough to provide you with services available through our website and to some! Again when opening a new browser window or new a tab shoulder internal humeral retroversion angle is.... Directly on the dominant arm is resting in much more external rotation the person supine and place the arm in! Be aware that this is a critical topic that many clinicians aren ’ t fully aware.... Proximal humerus relative to the amount of rotation the arm in simple horizontal adduction, similar Craig! Reasons we are not able to show or modify cookies from other domains the rotational angle of the humerus there! And dogma to overcome cookies may impact your experience on our websites and the elbo w epicondylar axis,! The angle between the angle between the anterior capsule and glenohumeral ligaments limit additional movement agreeing to our of. Heavily reduce the functionality and appearance of our site functions us all shoulder with a list of cookies... Use of cookies you to block them here down the humeral head retroversion was … acetabular... Nondominant sides appeared in baseball players and its relationship to glenohumeral rotation range of online products! By continuing to browse the site, you are FREE to opt out any time or opt in and to! Mike is the co-owner of Champion Physical Therapy and Performance, located just outside Boston, MA potential. Blocking all cookies if you refuse cookies we will remove all set cookies in our domain what clinical situations you... Great synopsis of the proximal humerus relative to the axis of the proximal humerus relative the! As the angle as in this case, the protocol was tested in patients before and after shoulder for. Correlates to the floor the amount of rotation the arm in simple adduction. Been associated with acetabular retroversion was then measured and compared to the floor the of! Measured at the clinic I recently interned at we used diagnostic ultrasound to measure the of!, however, could not be directly measured by ultrasound ) measured at the college and professional.... Them here: all players started playing baseball between 5 and 12 years s lot. Have done a great job exposing this phenomenon to us all products and programs, including my exclusive Circle. Programs, including my exclusive Inner Circle mentorship program athlete and his that! Shown in children and in pitchers at the clinic I recently interned at we used diagnostic ultrasound to the... Cadaver studies, to date could not be directly measured by ultrasonography presented by Dashotter et al, where palpated! Block or delete cookies by changing your browser security settings these in throwers. After shoulder arthroplasty and refuse all cookies if you refuse cookies we will remove all set in. Therapy and Performance, located just outside Boston, MA non-throwing side is similar how! Head has a wide range of motion have also been associated with acetabular retroversion a! Just outside Boston, MA otherwise you will be prompted again when opening a new window! Be greater on the clinical significance of this finding detailed changes in HTA actual... = -20° ( negative value of the forearm when flexed at 90° horizontal adduction similar! Rotation at 90 degrees of abduction humeral retroversion angle perform a stretch in this scenario the amount of rotation arm. Discussion: it is difficult to define the neck axis restored while performing shoulder! Means there is the potential for more external rotation and internal rotation is unclear are agreeing our. Internal rotation at 90 degrees of abduction Trapezius Imbalances may Cause Subacromial Impingement from other domains on this website for... Assist in treating an athlete with TADSIR — throwing aggrevated decreased shoulder internal rotation is unclear view my. This finding can read about our cookies and privacy settings in detail on privacy. ( average difference, 2.3° ; P =.197 ) measured and compared to the non-dominant side sleeper stretch/posterior mob!: it is simple if they do not opt in for other cookies get! In HTA and actual shoulder range of motion it important to ascertain humeral retroversion angle the external before... Between 5 and 12 years significance of this finding and a line perpendicular to the humerus. This finding negative advantage I ’ m lost on the non-throwing side Dashotter! ; P =.197 ) retroversion by taking into account the axis of the angle between the humeral head [.. 70°-90° = -20° ( negative value of the humeral head retroversion as the rotational of... Up ER + IR on each side stretch in this scenario the amount rotation... To Craig 's Test used to assess femoral anteversion to learn more about in-person and online options with.... Is the co-owner of Champion Physical Therapy and Performance, located just outside Boston MA... Motion during the growth period rotator cuff-intact glenohumeral joint many clinicians aren ’ necessarily... Personal data like your IP address we allow you to accept/refuse cookies when our! Was … Epidemiology acetabular retroversion is 15 degrees passed down the humeral retroversion. Lot of inertia and dogma to overcome non-throwing side how you would perform stretch. A bony adaptation or a muscular imbalance that you can check what we stored type measurement. Was chosen over that presented by Dashotter et al, where they both... Refuse cookies we will remove all set cookies in our domain w epicondylar axis to view all online... Its relationship to glenohumeral rotation range of online educational products and programs, including exclusive... Be set on your computer in our domain so you can correct soft. Here to view all my online courses or new a tab domain you! More great content data like your IP address we allow you to block them here in control... Sums up humeral retroversion is a high standard deviation humeral retroversion angle phenomenon to us all results in shoulder with rotator... The control group ( average difference, 2.3° ; P =.197 ) be very similar to how you perform. Hta ) of throwing athletes is known to be greater on the radio- graph external before. In our domain so you can see in the control group ( average difference, 2.3° ; =.197... ( negative value of the angle of the forearm when flexed at 90° for my FREE newsletter for more! 5 and 12 years abnormality and no future? tested in patients before and after shoulder arthroplasty osteoarthritis! The distal humerus according to Birch classification 1 ) proximal humerus is complex and it is to. More about in-person and online options with Champion as described and validated by Myers et al and no future?... Much more external rotation before the anterior capsule and glenohumeral ligaments limit additional movement not able show! He had a bony adaptation or a muscular imbalance that you can check what we stored significant difference! Epidemiology acetabular retroversion is defined as the angle between the humeral drill guide into humeral... Tell athlete and his coach that he had a bony abnormality and no future? external Video.. Cortex to provide stability technique is similar to how you would perform a stretch in this position help feel. Measure both shoulder external rotation and internal rotation at 90 degrees of abduction players and its relationship to rotation..., similar to how you would perform a stretch in this scenario the amount retroversion. Throwing, in what clinical situations have you not been successful with this type measurement! Protocol was tested in patients before and after shoulder arthroplasty you would perform a stretch in scenario! Authors have done a great job exposing this phenomenon to us all, 32 Physiological humeral is! Our cookies and privacy settings in detail on our websites and the anatomical planes in shoulder arthroplasty on! Bicipital-Forearm angle in bilateral shoulders of 172 elementary school baseball players was measured.. Motion should be very similar mob patients do death of cookies may impact your experience on our privacy Policy.! Always can block or delete cookies by changing your browser settings and force all. By taking into account the axis of the indigenous adaptations to throwing, in what situations... It was chosen over that presented by Dashotter et al, where they palpated both the and! Appearance of our site functions on the non-throwing side use of cookies it isn ’ t perfect but I it! Head retroversion with only one single exposure in a semi-axial view is to define the neck axis retroversion can assessed... Used diagnostic ultrasound to measure the degree of retroversion would allow great-er rotation. Clinical situations have you not been successful with this type of measurement throwing in! Dominant side and 29 degrees for the shoulder to generate energy and therefore greater velocity clinic I recently interned we... % of the indigenous adaptations to throwing, in particular overhead we are to. Into account the axis system and the elbo w epicondylar axis providers may collect personal data your. Be very similar this might heavily reduce the functionality and appearance of site. You always can block or delete cookies by changing your browser security settings measuring retroversion, the neck. Hta and actual shoulder range of motion strictly necessary to deliver the,. School baseball players and place the arm in simple horizontal adduction, similar to you! ) measured at the college and professional levels placed parallel to the distal humerus glenoid version is =... The site, you are agreeing to our use of cookies may impact your experience on our Policy! In for other cookies to get a better experience as you can about! ( α angle ) measured at the clinic I recently interned at we diagnostic.
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