CT Scan Method Accurately Assesses Humeral Head Retroversion

Humeral head retroversion is not well described with the literature controversial regarding accuracy of measurement methods and ranges of normal values. We therefore determined normal humeral head retroversion and assessed the measurement methods. We measured retroversion in 65 cadaveric humeri, including 52 paired specimens, using four methods: radiographic, computed tomography (CT) scan, computer-assisted, and direct methods. We also assessed the distance between the humeral head central axis and the bicipital groove. CT scan methods accurately measure humeral head retroversion, while radiographic methods do not. The retroversion with respect to the transepicondylar axis was 17.9° and 21.5° with respect to the trochlear tangent axis. The difference between the right and left humeri was 8.9°. The distance between the central axis of the humeral head and the bicipital groove was 7.0 mm and was consistent between right and left humeri. Humeral head retroversion may be most accurately obtained using the patient’s own anatomic landmarks or, if not, identifiable retroversion as measured by those landmarks on contralateral side or the bicipital groove.

[1]  T. J. Allardyce,et al.  Modular total shoulder replacement. Design rationale, indications, and results. , 1994, Clinical Orthopaedics and Related Research.

[2]  M. Kronberg,et al.  Radiologic Assessment of Humeral Head Retroversion , 1989, Acta radiologica.

[3]  C. Martin.  The Cause of Torsion of the Humerus and of the Notch on the Anterior Edge of the Glenoid Cavity of the Scapula. , 1933, Journal of anatomy.

[4]  P Van Roy,et al.  Arthro-kinematics of the elbow: study of the carrying angle , 2005, Ergonomics.

[5]  R. Cofield.  Unconstrained total shoulder prostheses. , 1983, Clinical orthopaedics and related research.

[6]  F. G. Evans,et al.  Humeral torsion in man , 1945 .

[7]  P Boileau,et al.  The three-dimensional geometry of the proximal humerus. Implications for surgical technique and prosthetic design. , 1997, The Journal of bone and joint surgery. British volume.

[8]  J. London.  Kinematics of the elbow. , 1981, The Journal of bone and joint surgery. American volume.

[9]  R. Burks,et al.  Comparison of humeral head retroversion with the humeral axis/biceps groove relationship: a study in live subjects and cadavers. , 1998, Journal of shoulder and elbow surgery.

[10]  F L STEEL,et al.  The carrying angle in man. , 1958, Journal of anatomy.

[11]  C. Neer.  Articular replacement for the humeral head. , 1955, The Journal of bone and joint surgery. American volume.

[12]  A. K. Saha.  Dynamic stability of the glenohumeral joint. , 1971, Acta orthopaedica Scandinavica.

[13]  M. Kronberg,et al.  Retroversion of the humeral head in the normal shoulder and its relationship to the normal range of motion. , 1990, Clinical orthopaedics and related research.

[14]  R Zehnder,et al.  The subcoracoid space. An anatomic study. , 1987, Clinical orthopaedics and related research.

[15]  S. Nielsen,et al.  Prosthesis position in shoulder arthroplasty. A cadaver study of the humeral component. , 1985, Acta orthopaedica Scandinavica.

[16]  M. Pearl,et al.  Retroversion of the proximal humerus in relationship to prosthetic replacement arthroplasty. , 1995, Journal of shoulder and elbow surgery.

[17]  G. Walch,et al.  [Radio-cinematographic study of active elevation of the prosthetic shoulder]. , 1992, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[18]  M. Pearl.  Proximal humeral anatomy in shoulder arthroplasty: Implications for prosthetic design and surgical technique. , 2005, Journal of shoulder and elbow surgery.

[19]  M. Leunig,et al.  Surgical landmarks to determine humeral head retrotorsion for hemiarthroplasty in fractures. , 2001, Journal of shoulder and elbow surgery.

[20]  Pieper Hg.  Shoulder dislocation in skiing: choice of surgical method depending on the degree of humeral retrotorsion. , 1985 .

[21]  P. Vuagnat,et al.  Humeral retrotorsion and glenohumeral relationship in the normal shoulder and in recurrent anterior dislocation (scapulometry). , 1983, Clinical orthopaedics and related research.

[22]  G. Edelson.  Variations in the retroversion of the humeral head. , 1999, Journal of shoulder and elbow surgery.

[23]  C. Dujardin,et al.  A study of reproducibility of an original method of CT measurement of the lateralization of the intertubercular groove and humeral retroversion , 2003, Surgical and Radiologic Anatomy.

[24]  Ulf Knothe,et al.  Geometry of the proximal humerus and implications for prosthetic design. , 2002, Journal of shoulder and elbow surgery.

[25]  T. Wickiewicz,et al.  Instability of the shoulder after arthroplasty. , 1993, The Journal of bone and joint surgery. American volume.

[26]  Hyatt Gw,et al.  Humeral torsion in recurrent shoulder dislocations. A technic of determination by X-ray. , 1971 .

[27]  M. Randelli,et al.  Glenohumeral osteometry by computed tomography in normal and unstable shoulders. , 1986, Clinical orthopaedics and related research.

[28]  D D Robertson,et al.  Three-Dimensional Analysis of the Proximal Part of the Humerus: Relevance to Arthroplasty* , 2000, The Journal of bone and joint surgery. American volume.

[29]  R. Warren,et al.  The coracoid impingement syndrome. , 1990, The Journal of bone and joint surgery. British volume.

[30]  Mehmet Bulut,et al.  Variation of carrying angle with age, sex, and special reference to side. , 2005, Orthopedics.

[31]  F. Balg,et al.  Bicipital groove orientation: considerations for the retroversion of a prosthesis in fractures of the proximal humerus. , 2006, Journal of shoulder and elbow surgery.

[32]  F. G. Evans,et al.  The torsion of the humerus: A phylogenetic survey from fish to man , 1945 .

[33]  L. Bigliani,et al.  Arthroplasty and acute shoulder trauma. Reasons for success and failure. , 1994, Clinical orthopaedics and related research.

[34]  G. W. Hyatt,et al.  Humeral torsion in recurrent shoulder dislocations. A technic of determination by X-ray. , 1971, Clinical orthopaedics and related research.

[35]  M. Freeman,et al.  Ten-year survival of the cemented Freeman-Samuelson primary knee arthroplasty. Data from the Swedish Knee Arthroplasty Register and the Royal London Hospital. , 2000, The Journal of bone and joint surgery. British volume.

[36]  J. Tibone,et al.  Analysis of the bicipital groove as a landmark for humeral head replacement. , 2002, Journal of shoulder and elbow surgery.

[37]  James A. Johnson,et al.  An anthropometric study of the bilateral anatomy of the humerus. , 2007, Journal of shoulder and elbow surgery.

[38]  J. Damilakis,et al.  An individualized approach for the implantation of a humeral prosthesis with the proper retroversion in fractures , 2001, Archives of Orthopaedic and Trauma Surgery.

[39]  F. Kummer,et al.  The use of the bicipital groove for alignment of the humeral stem in shoulder arthroplasty. , 1998, Journal of shoulder and elbow surgery.

[40]  E. Tillett,et al.  Anatomic determination of humeral head retroversion: The relationship of the central axis of the humeral head to the bicipital groove. , 1993, Journal of shoulder and elbow surgery.

[41]  M. Kronberg,et al.  Humeral head retroversion in patients with unstable humeroscapular joints. , 1990, Clinical orthopaedics and related research.

[42]  V E KRAHL,et al.  The torsion of the humerus; its localization, cause and duration in man. , 1947, The American journal of anatomy.

[43]  N. Ito,et al.  Ultrasonographic measurement of humeral torsion. , 1995, Journal of shoulder and elbow surgery.

[44]  J. Damilakis,et al.  The bicipital groove as a landmark for orientation of the humeral prosthesis in cases of fracture. , 2001, Journal of shoulder and elbow surgery.

[45]  S N Roberts,et al.  The geometry of the humeral head and the design of prostheses. , 1991, The Journal of bone and joint surgery. British volume.

[46]  S. Hasan,et al.  Characteristics of unsatisfactory shoulder arthroplasties. , 2002, Journal of shoulder and elbow surgery.

[47]  A. Hernigou,et al.  Determining Humeral Retroversion with Computed Tomography , 2002, The Journal of bone and joint surgery. American volume.

[48]  J. Bernageau.  [Imaging of the shoulder in orthopedic pathology]. , 1990, La Revue du praticien.

[49]  C. Neer,et al.  Recent experience in total shoulder replacement. , 1982, The Journal of bone and joint surgery. American volume.

[50]  D. Palma,et al.  Surgery of the Shoulder , 1951, The Indian Medical Gazette.

[51]  P Boileau,et al.  Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. , 2002, Journal of shoulder and elbow surgery.