Humeral head retroversion is known to be high in the fetus and infant 13 and to become smaller with growth.12, 32 Thus, a high-demand situation is thought to obstruct normal derotation during growth. Humeral head retroversion is important in a variety of clinical situations, but it is not known when retroversion actually develops to adult values. A fractured neck of humerus … Tested Concept, (OBQ11.218) Tested Concept, Glenoid osteotomy and interposition arthroplasty, (OBQ06.142) The humerus is the bone of the upper arm. Retroversion of the humeral head and the range of motion of the shoulder joint in both the frontal and the scapular plane have been studied in 100 shoulder joints in 50 healthy subjects, 25 men and 25 women. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. Which of the following is the most likely cause of this limitation? Radiograph in the semi-axial view. The average angle for humeral head retroversion was … of the humeral head and the paleoglenoid that is the native anterior glenoid face that is untouched by the humeral head wear. In a study of 120 cadaveric humeri, Hernigou et al9 used CT to measure humeral retro-version and reported that the average humeral head retroversion was 28.8° with reference to the forearm axis. MB BULLETS Step 1 For 1st and 2nd Year Med Students. Glenohumeral Joint Anatomy, Stabilizer, and Biomechanics, Traumatic Anterior Shoulder Instability (TUBS), Posterior Shoulder Instability & Dislocation, Multidirectional Shoulder Instability (MDI), Luxatio Erecta (Inferior Glenohumeral Joint Dislocation), Glenohumeral Internal Rotation Deficit (GIRD), Brachial Neuritis (Parsonage-Turner Syndrome), Valgus Extension Overload (Pitcher's Elbow), Lateral Ulnar Collateral Ligament Injury (PLRI), glenohumeral degenerative joint disease characterized by, joint comprised of  humeral head and glenoid fossa of scapula, decreased external rotation, forward flexion, and internal rotation, variable and more active patients have better range of motion (ROM), osteophytes circumferentially at humeral head, “goat’s beard”, fixed posterior humeral head subluxation (due to tight anterior capsule), articular surface incongruities due to healed fractures, repeat attacks may show osteopenia/erosions, crescent sign (lucency) indicating subchondral collapse, flattening/collapse in more advanced stages, “acetabularization” of coracoacromial arch, evaluate glenoid morphology and rotator cuff pathology for pre-operative planning, may underestimate full-thickness RCTs and fatty infiltration/muscle atrophy compared to MRI, evaluate rotator cuff pathology for pre-operative planning, less accurate than CT in distinguishing between glenoid types, OA or RA with significant glenoid pathology, convex glenoid (ball) and concave humerus (cup) to reconstruct joint, Good pain relief, improved shoulder function, Common complications:  scapular notching, infection, dislocation/instability, nerve injuries; higher reported complication rates than TSA, combination of arthroscopic glenohumeral debridement, chondroplasty, synovectomy, loose body removal, humeral osteoplasty with excision of the goat's beard osteophyte, capsular releases, subacromial and subcoracoid decompressions, axillary nerve decompression, and biceps tenodesis. Humeral head retroversion was replicated from the diseased humeral head as closely as possible. humeral head retroversion has been considered normal. Number of displaced fragments - 2 part (head/shaft, GT, LT) - 3 part (head/shaft/GT, head/shaft/LT) Morphologic features of the humeral head and glenoid version in the normal glenohumeral joint. Average glenoid retroversion was 1° ± 3°, ranging from -9° to 13°. To evaluate this method of measuring retroversion, the protocol was tested in patients before and after shoulder arthroplasty. damage to the articular surfaces of the humeral head and/or glenoid, 56% of patients who had primary anterior dislocation have arthrosis at 25 years follow up, irreversible progressive loss of articular cartilage with, hypertrophic reaction of the subchondral bone, thinning/absence of cartilage, flattening, osteophyte and subchondral cyst formation, posterior humeral subluxation, rotator cuff tears incidence 5-10%, important to rule out, articular surface incongruities following trauma healing can lead to joint deterioration, commonly occurs in patients with humeral fractures and chronic dislocations, torn rotator cuff tendons leads to humeral head migration and subsequent abrasive contact between the humeral head and acromion which leads to articular wear, repeated dislocation can cause erosion of joint cartilage, not associated with number of dislocations, excessive tightening of soft tissues in stabilization surgeries to treat recurrent dislocation forces humeral head in one direction, systemic autoimmune disease causes synovial inflammation and degradation of shoulder joint, can involve all structures of shoulder including soft tissue, characterized by central glenoid wear and medialization of humeral head, calcium pyrophosphate dihydrate deposition disease (CPPD), accumulation of calcium pyrophosphate crystals within joint space causing synovial inflammatory response and cartilage/bone damage; sometimes referred to as “pseudogout”, accumulation of sodium urate crystals within joint due to hyperuricemia causing inflammatory attack within joint and cartilage/bone damage, bone cell death caused by interruption of blood supply to humeral head leads to subchondral bone collapse and morphological/arthritic changes, exact pathophysiology unknow but associated with, leads to the dissolution of articular cartilage, Concentric wear, no subluxation of HH, well centered, Biconcave glenoid, asymmetric glenoid wear and head subluxated posteriorly, • Glenoid anteversion or anterior HH subluxation (HH subluxation <40%), worse with activities involving shoulder motion, a carefully evaluation of the rotator cuff muscles should be performed, central glenoid wear and medialization of humeral head, physical therapy – improve range of motion with capsular stretching, biologics (platelet rich plasma, stem cell) – limited evidence, concave glenoid (cup) and convex humerus (ball) to reconstruct joint, most common complications: glenoid/humeral component loosening, infection, fracture, nerve injury and rotator cuff tear, rheumatoid arthritic patients with irreparable RC tears/insufficient bone stock, osteonecrosis without glenoid involvement, humeral head replacement ± biologic resurfacing, humeral head prosthesis & glenoid reaming to provide a stabilizing concavity and maximize glenohumeral contact area for load transfer, indicated in young patients with intact rotator cuff and no inflamatory arthropathy, mild to moderate OA without structural alternation, mechanical symptoms due to loose bodies or small lesions of humeral head due to AVN, temporizing treatment; improves ROM and pain, less successful in those with more rapid degenerative changes, may see better results in patients who also had subacromial procedures, severe soft tissue deficiency; poor deltoid function, persistent symptomatic instability with failed repair, Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)), Arthroplasty, glenohumeral joint; hemiarthroplasty. A 74-year-old female trips over the curb in a parking lot and sustains the shoulder injury shown in Figures A and B. position of humeral stem should be 25-45° of retroversion . A fractured neck of humerus … An open reduction and humeral hemiarthroplasty is performed. Tested Concept, (OBQ09.22) of retroversion of the humeral head when compared with the humeral shaft (Fig 9). repeated dislocation can cause erosion of joint cartilage This study was conducted to compare the concordance and reliability between the standard method and 5 other measurement methods on two-dimensional (2D) computed tomography (CT) scans.CT scans from 21 patients who underwent shoulder arthroplasty (19 women and 2 men; mean age, 70.1 years [range, … Abstract. Results: The values of humeral head retroversion were widely distributed from -2° to 60°, with an average of 26° ± 11°. Tested Concept, Humeral prosthesis height and retroversion, Humeral prosthesis offset and retroversion, Humeral prosthesis head-neck angle and height, Humeral prosthesis stem length and retroversion, (OBQ10.103) Centered form: Upward migration absent, uniform glenoid wear, Humeral head pushes into glenoid, progressive head medialisation, eventual reduction in acromio-humeral distance. congruent w/ humeral surface; - grafts are fixed to the humeral head w/ a 3.5 mm cancellous lag screws; - references: - Recurrent posterior dislocation of the shoulder: treatment using a bone block. More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. J Orthop Sports Phys Ther. Tested Concept, (OBQ07.5) ... excessive retroversion of humeral components leads to? Tested Concept, (OBQ04.271) Radiographs are shown in Figures A and B. By studying a unique collection of children's bones (180 … Which of the following factors has the lowest association with humeral head ischemia in these injuries? On physical exam his rotator cuff strength is 5/5. Results. Six months following surgery, she denies shoulder pain, but she is unable to actively raise her hand above her shoulder. In comparison to patients with osteoarthritis, patient with inflammatory arthritis undergoing shoulder arthroplasty are more likely to have? The humeral head retroversion angle is marked with alpha. 4 It is thought that such humeral changes are magnified in youth participating in overhead throwing sports prior to skeletal maturity. The boundary of the surface of the humeral head is marked with line B-C. Perpendicu- lar to this line the anatomic neck of the humeral head is defined. 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. 3. Tested Concept, (OBQ11.14) Group 3: Gleno-humeral joint space narrowing minimal, Bony destruction / lysis of acromion or humeral head… Clin Orthop Rel Res. A radiograph of his shoulder obtained the next day in the emergency room is shown in Figure A. A 31-year-old male sustained a displaced proximal humerus fracture after a motor vehicle accident. Humeral head retroversion is important in a variety of clinical situations, but it is not known when retroversion actually develops to adult values. Humeral retroversion isn’t necessarily a bad thing. 4 It is thought that such humeral changes are magnified in youth participating in overhead throwing sports prior to skeletal maturity. A 60-year-old woman is undergoing closed reduction and percutaneous pinning of a proximal humerus fracture. A comminuted proximal humerus fracture is treated with a shoulder hemiarthroplasty as shown in Figure A. - Treatment of locked chronic posterior dislocation of the shoulder by reconstruction of the defect in the humeral head with an allograft. However, Boileau et al8 determined that average retroversion was 17.9° with respect to the transepicondylar Results. Humeral retroversion is a well know entity in overhead athletes. A 69-year-old woman falls while getting out of her car and lands on her right shoulder sustaining a 4-part proximal humerus fracture. or excessive ante version? A 68-year-old man had a 3-year history of shoulder pain that failed to respond to nonsurgical management. Study 87 Shoulder procedures orthobullets flashcards from Kevin P. on StudyBlue. Radiograph in the semi-axial view. 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