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VOLUME 15 , ISSUE 2 ( May-August, 2020 ) > List of Articles

Original Article

Humeral Retroversion (Complexity of Assigning Reference Axes in 3D and Its Influence on Measurement): A Technical Note

Fabian van de Bunt, Michael L Pearl, Arthur van Noort

Keywords : Humeral retroversion, Humeral torsion, Humerus, Shoulder, Shoulder arthroplasty,Computer tomography

Citation Information : van de Bunt F, Pearl ML, van Noort A. Humeral Retroversion (Complexity of Assigning Reference Axes in 3D and Its Influence on Measurement): A Technical Note. 2020; 15 (2):69-73.

DOI: 10.5005/jp-journals-10080-1463

License: CC BY-NC-SA 4.0

Published Online: 01-01-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Background: Humeral retroversion (RV) is important to the study of shoulder function and reconstruction. This study tests the hypothesis that clinically obtained computer tomography (CT) measurements for humeral RV (off-axis measurements) differ from those obtained after reformatting the image slice orientation so that the humeral shaft is perpendicular to the gantry (coaxial measurements) and explores deviations from true RV. Materials and methods: A custom-built application created in Mathematica was used to explore the effect of altering the humeral orientation on slice angle acquisition by 3D imaging technologies, on the perceived angle of RV from the 2D-projection of the reference axes. The application allows for control of humeral axis orientation relative to image slice (3D) or plain of projection (2D) and humeral rotation. The effect of rotating a virtual model of one humerus around its own axis and in discrete anatomical directions on the measured RV angle was assessed. Results: The coaxial measurement of humeral RV (31.2°) differed from off-axis measurement, with a maximum difference in measured RV of 50° in 45° of extension. The typical position of the humerus in a CT scan resulted in a difference in RV measurement up to 22°. Explorations of deviation led to the following outcomes, as divided by anatomic direction. Extension and abduction led to an underestimation, and flexion and adduction led to an overestimation of the RV-angle. Conclusion: Measurements must be done consistently about the position and orientation of the humerus. Deviation in the humeral alignment of as little as 10° can distort the measurement of version up to 15°.

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  1. Osbahr DC, Cannon DL, Speer KP. Retroversion of the humerus in the throwing shoulder of college baseball pitchers. Am J Sports Med 2002;30(3):347–353. DOI: 10.1177/03635465020300030801.
  2. Pearl ML, Batech M, van de Bunt F. Humeral retroversion in children with shoulder internal rotation contractures secondary to upper-trunk neonatal brachial plexus palsy. J Bone Joint Surg Am 2016;98(23):1988–1995. DOI: 10.2106/JBJS.15.01132.
  3. Boileau P, Bicknell RT, Mazzoleni N, et al. CT scan method accurately assesses humeral head retroversion. Clin Orthop Relat Res 2008;466(3):661–669. DOI: 10.1007/s11999-007-0089-z.
  4. Hernigou P, Duparc F, Hernigou A, et al. Determining humeral retroversion with computed tomography. J Bone Joint Surg 2002;84(10):1753–1762. DOI: 10.2106/00004623-200210000-00003.
  5. Sheehan FT, Brochard S, Behnam AJ, et al. Three-dimensional humeral morphologic alterations and atrophy associated with obstetrical brachial plexus palsy. J Shoulder Elbow Surg 2014;23(5):708–719. DOI: 10.1016/j.jse.2013.08.014.
  6. Whiteley R, Adams R, Ginn K, et al. Playing level achieved, throwing history, and humeral torsion in masters baseball players. J Sports Sci 2010;28(11):1223–1232. DOI: 10.1080/02640414.2010.498484.
  7. Boileau P, Walch G. The three-dimensional geometry of the proximal humerus: implications for surgical technique and prosthetic design. J Bone Joint Surg 1997;79(5):857–865. DOI: 10.1302/0301-620X.79B5.0790857.
  8. Debevoise NT, Hyatt GW, Townsend GB. Humeral torsion in recurrent shoulder dislocations. Clin Orthop Relat Res 1971;76:87–93. DOI: 10.1097/00003086-197105000-00013.
  9. Hasan SS, Leith JM, Campbell B, et al. Characteristics of unsatisfactory shoulder arthroplasties. J Shoulder Elbow Surg 2002;11(5):431–441. DOI: 10.1067/mse.2002.125806.
  10. Neer 2nd CS. Articular replacement for the humeral head. J Bone Joint Surg 1955;37-A(2):215–228. DOI: 10.2106/00004623-195537020-00001.
  11. Pearl ML. Proximal humeral anatomy in shoulder arthroplasty: implications for prosthetic design and surgical technique. J Shoulder Elbow Surg 2005;14(1 Suppl S):99S–104S. DOI: 10.1016/j.jse.2004.09.025.
  12. Harrold F, Wigderowitz C. A three-dimensional analysis of humeral head retroversion. J Shoulder Elbow Surg 2012;21(5):612–617. DOI: 10.1016/j.jse.2011.04.005.
  13. Ibarra C, Craig EV. Soft-tissue balancing in total shoulder arthroplasty. Orthop Clin North Am 1998;29(3):415–422. DOI: 10.1016/S0030-5898(05)70017-1.
  14. Balg F, Boulianne M, Boileau P. Bicipital groove orientation: considerations for the retroversion of a prosthesis in fractures of the proximal humerus. J Shoulder Elbow Surg 2006;15(2):195–198. DOI: 10.1016/j.jse.2005.08.014.
  15. Chant CB, Litchfield R, Griffin S, et al. Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion. J Orthop Sports Phys Ther 2007;37(9):514–520. DOI: 10.2519/jospt.2007.2449.
  16. Kronberg M, Broström LÄ, Söderlund V. Retroversion of the humeral head in the normal shoulder and its relationship to the normal range of motion. Clin Orthop Relat Res 1990(253):113–117.
  17. Matsumura N, Ogawa K, Kobayashi S, et al. Morphologic features of humeral head and glenoid version in the normal glenohumeral joint. J Shoulder Elbow Surg 2014;23(11):1724–1730. DOI: 10.1016/j.jse.2014.02.020.
  18. Zhang L, Yuan B, Wang C, et al. Comparison of anatomical shoulder prostheses and the proximal humeri of Chinese people. Proc Inst Mech Eng H 2007;221(8):921–927. DOI: 10.1243/09544119JEIM267.
  19. Söderlund V, Kronberg M, Broström LÄ. Radiological assessment of humeral head retroversion. Acta radiol 1989;30(5):501–505. DOI: 10.1177/028418518903000511.
  20. Bokor DJ, O’Sullivan MD, Hazan GJ. Variability of measurement of glenoid version on computed tomography scan. J Shoulder Elbow Surg 1999;8(6):595–598. DOI: 10.1016/S1058-2746(99)90096-4.
  21. Hoenecke HR, Hermida JC, Flores-Hernandez C, et al. Accuracy of CT-based measurements of glenoid version for total shoulder arthroplasty. J Shoulder Elbow Surg 2010;19(2):166–171. DOI: 10.1016/j.jse.2009.08.009.
  22. Hermann KL, Egund N. CT measurement of anteversion in the femoral neck. The influence of femur positioning. Acta Radiol 1997;38(4 Pt 1):527–532.
  23. Olesen TH, Torfing T, Overgaard S. MPR realignment increases accuracy when measuring femoral neck anteversion angle. Skeletal Radiol 2013;42(8):1119–1125. DOI: 10.1007/s00256-013-1639-y.
  24. Saka M, Yamauchi H, Yoshioka T, et al. Conventional humeral retroversion measurements using computed tomography slices or ultrasound images are not correlated with the 3-dimensional humeral retroversion angle. Orthop J Sport Med 2015;3(3):1–7. DOI: 10.1177/2325967115573701.
  25. Farrokh D, Fabeck L, Descamps PY, et al. Computed tomography measurement of humeral head retroversion: influence of patient positioning. J Shoulder Elbow Surg 2001;10(6):550–553. DOI: 10.1067/mse.2001.118412.
  26. Polster JM, Subhas N, Scalise JJ, et al. Three-dimensional volume-rendering computed tomography for measuring humeral version. J Shoulder Elbow Surg 2010;19(6):899–907. DOI: 10.1016/j.jse.2009.11.047.
  27. Spitzer VM, Whitlock DG. The visible human dataset: the anatomical platform for human simulation. Anat Rec 1998;253(2):49–57. DOI: 10.1002/(SICI)1097-0185(199804)253:2<49::AID-AR8>3.0. CO;2-9.
  28. van der Sluijs JA, van Ouwerkerk WJR, De Gast A. Retroversion of the humeral head in children with an obstetric brachial plexus lesion. J Bone Joint Surg 2002;84(4):583–587. DOI: 10.1302/0301-620X.84B4.0840583.
  29. Doyle AJ, Burks RT. Comparison of humeral head retroversion with the humeral axis/biceps groove relationship: a study in live subiects and cadavers. J Shoulder Elbow Surg 1998;7(5):453–457. DOI: 10.1016/S1058-2746(98)90193-8.
  30. Hempfing A, Leunig M, Ballmer FT, et al. Surgical landmarks to determine humeral head retrotorsion for hemiarthroplasty in fractures. J Shoulder Elbow Surg 2001;10(5):460–463. DOI: 10.1067/mse.2001.117127.
  31. van de Bunt F, Pearl ML, Lee EK, et al. Glenoid version by CT scan: an analysis of clinical measurement error and introduction of a protocol to reduce variability. Skeletal Radiol 2015;44(11):1627–1635. DOI: 10.1007/s00256-015-2207-4.
  32. Zale CL, Pace GI, Lewis GS, et al. Interdepartmental imaging protocol for clinically based three-dimensional computed tomography can provide accurate measurement of glenoid version. J Shoulder Elbow Surg 2018;27(7):1297–1305. DOI: 10.1016/j.jse.2017.11.020.
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