RC - supplies blood to tuberosities in fractures. 3. Copyright © 2021 Lineage Medical, Inc. All rights reserved. Tested Concept, (OBQ07.5) of retroversion of the humeral head when compared with the humeral shaft (Fig 9). torn rotator cuff tendons leads to humeral head migration and subsequent abrasive contact between the humeral head and acromion which leads to articular wear; dislocation arthropathy. 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. CT scan method accurately assesses humeral head retroversion. Examination reveals forward elevation to 120 degrees and external rotation to 30 degrees. Neer Classification 1970. Which of the following could have best prevented the complication shown in the current radiograph shown in Figure A? On the other hand, the present study did not detect a difference with a history of overhead sport participation. Upper extremity physical exam reveals no neurologic deficits, and an initial radiograph of the shoulder is shown in Figure A. no callous on radiograph and gross motion at the fracture site at 6 weeks from injury has a 90-100% PPV of going on to nonounion in closed humeral shaft fractures ; Malunion. commonly occurs in patients with humeral fractures and chronic dislocations; cuff tear arthropathy . 4. What structure is 7cm from the acromion and at greatest risk of injury during a deltoid splitting approach for a proximal humerus fracture? Tested Concept, Closed reduction and sling immobilization for 6 weeks, Closed reduction and sling immobilization for 2 weeks followed by early active range of motion exercises, (SBQ12TR.97) Pseudodislocation of the shoulder results from an occult fracture with distension of the glenohumeral joint due to hemarthrosis that causes inferior displacement of the humeral head compared to the glenoid.. The “ball” is the head of the humerus. MB BULLETS Step 1 For 1st and 2nd Year Med Students. Posterior Humeral circumflex. Measurement The shortest distance is measured. A 68-year-old man had a 3-year history of shoulder pain that failed to respond to nonsurgical management. A humerus fracture is a break in the large bone of your upper arm. The average angle for humeral head retroversion was … The epicondylar axis is marked with line D-E. Humeral retroversion is a well know entity in overhead athletes. Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). A 72-year-old man reports progressive pain and restriction of motion in his left shoulder. Humeral head greater and lesser tuberosities are attachment sites for the rotator cuff; spheroidal in shape in 90% of individuals; average diameter is 43 mm; approximate retroversion 20° from transepicondylar axis of the distal humerus A 74-year-old female trips over the curb in a parking lot and sustains the shoulder injury shown in Figures A and B. Morphologic features of the humeral head and glenoid version in the normal glenohumeral joint. Results. raise articular surface and fill defects2. 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.A significant side-to-side difference was not observed in the control group (average difference, 2.3°; P = .197). The shoulder, because of its wide range of motion, is anatomically predisposed to instability, but the vast majority of shoulder instability is anterior, with posterior instability estimated to affect 2-10% of unstable shoulders.1 Although anterior shoulder dislocations have been recognized since the da… The humeral head retroversion angle is marked with alpha. aspect of the humeral shaft for distal fracture patterns. 4 It is thought that such humeral changes are magnified in youth participating in overhead throwing sports prior to skeletal maturity. An MRI is performed and shows no evidence of a rotator cuff tear. of the humeral head and the paleoglenoid that is the native anterior glenoid face that is untouched by the humeral head wear. Group 3: Gleno-humeral joint space narrowing minimal, Bony destruction / lysis of acromion or humeral head… Two investigators performed the humeral version measurements. PSH was reversed in 21/23 patients following TSA with an average final subluxation index of 50% (range, 40-68%; P = .001). Tested Concept, Glenoid osteotomy and interposition arthroplasty, (OBQ06.142) 3. True AP and axillary radiographs and an axial CT scan are shown in Figures 1a through 1c. ORTHO BULLETS Orthopaedic Surgeons & Providers 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. She subsequently undergoes surgery to treat the fracture, with immediate postoperative radiographs shown in Figure A. third most common non-vertebral fracture pattern seen in, two-part surgical neck fractures are most common, increasing age associated with more complex fracture types, concomitant soft tissue and neurovascular injuries, predictors of humeral head ischemia (Hertel criteria), uncommon (incidence 5-6%), higher likelihood in older patients, most often occur at level of surgical neck or with subcoracoid dislocation of the head, more often involved in fractures than anatomic neck, pectoralis major displaces shaft anteriorly and medially, supraspinatus, infraspinatus, and teres minor externally rotate greater tuberosity, subscapularis interally rotates articular segment or lesser tuberosity, attaches to coracoid and greater tuberosity and strengthens the rotator interval, large number of anastamoses with other vessels in the proximal humerus, organizes fractures into 3 main groups and additional subgroups based on, based on anatomic relationship of 4 segments, combined cortical thickness (medial + lateral thickness >4 mm), studies suggest correlation with increased lateral plate pullout strength, pseudosubluxation (inferior humeral head subluxation) caused by blood in the capsule and muscular atony, humeral head or greater tuberosity position uncertain, useful to identify associated rotator cuff injury, sling immobilization followed by progressive rehabilitation, most proximal humerus fractures can be treated nonoperatively including, 3-part and valgus-impacted 4-part fractures in patients with, good bone quality, minimal metaphyseal comminution, and, 3-, and 4-part fractures in younger patients, combined proximal humerus and humeral shaft fractures, biomechanically inferior with torsional stress compared to plates, favorable rates of fracture healing and ROM compared to ORIF, in younger patients (40-65 years old) with complex fracture-dislocations or head-splitting components that may fail fixation, recommended use of convertible stems to permit easier conversion to RSA if necessary in future, anatomic tuberosity reduction and healing, • ORIF v. hemiarthroplasty v. reverse total shoulder arthroplasty in elderly, • Minimally displaced (GT<5 mm; articular segment <1 cm and <45 degrees), - hemiarthroplasty v. reverse total shoulder arthroplasty, Sling immobilization followed by progressive rehabilitation, CRPP (closed reduction percutaneous pinning), use threaded pins but do not cross cartilage, externally rotate shoulder during pin placement, engage cortex 2 cm inferior to inferior border of humeral head, risk of injury to biceps tendon, musculocutaneous n., cephalic vein, igure-of-8 technique should be used for isolated greater tuberosity fx reduction and fixation (avoid hardware due to impingement), may be used for greater tuberosity fx reduction and fixation in young patients with good bone stock, more elastic than blade plate making it a better option in osteoporotic bone, lateral to the bicipital groove and pectoralis major tendon, lock nail with trauma or pathologic fractures, straight nails are placed through the superior articular cartliage (more central entry point), rod migration in older patients with osteoporotic bone is a concern, shoulder pain from violating rotator cuff, nerve injury with interlocking screw placement, cerclage wire or suture passed through hole in prosthesis and tuberosities improves fracture stability, greater tuberosity ~8 mm below articular surface of humeral head, nonanatomic placement of tuberosities results in impairment in external rotation kinematics with an 8-fold increase in torque requirements, height of the prosthesis best determined off the, superior edge of the pectoralis major tendon, 5.6cm between top of humeral head and superior edge of tendon, post-operative passive external rotation places the most stress on the lesser tuberosity fragment, repair of tuberosities recommended despite ability of RSA design to compensate for non-functioning tubersosities/rotator cuff, advanced stretching and strengthening program, no relationship to type of fixation (plate or cerclage wires), increased risk with lateral (deltoid-splitting) approach, axillary nerve is usually found ~5-7cm distal to the tip of the acromion, results inferior if converting from varus malunited fracture to TSA, use reverse shoulder arthroplasty instead, treatment of chronic nonunion/malunion in the elderly should include arthroplasty, lesser tuberosity nonunion leads to weakness with lift-off testing, greater tuberosity nonunion after arthroplasty leads to lack of active shoulder elevation, greatest risk factors for non-union are age and smoking, consider in all patients with llesser tuberosity fracture, Arthroplasty, glenohumeral joint; hemiarthroplasty, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Malunion and Nonunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Tested Concept, (OBQ11.230) Abstract. Which of the following factors has the lowest association with humeral head ischemia in these injuries? transverse fracture patterns; Radial nerve palsy Radiograph in the semi-axial view. 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.A significant side-to-side difference was not observed in the control group (average difference, 2.3°; P = .197). Which of the following is true regarding this injury? Based on the literature, retroversion of the humeral head is shown as a positive value and anteversion is shown as a negative value. A radiograph of his shoulder obtained the next day in the emergency room is shown in Figure A. Based on his radiograph shown in Figure A and physical exam, where is glenoid wear most likely to exist? Humeral retroversion isn’t necessarily a bad thing. Tested Concept, Sling and swathe for 6 weeks then physical therapy, Closed reduction and percutaneous pinning of the greater tuberosity, (SBQ07SM.16) More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. His active and passive motion are restricted to 90 degrees of forward elevation and neutral external rotation. When utilizing the pectoralis major tendon as a reference for restoring humeral height during shoulder hemiarthroplasty, at what level cephalad to the proximal edge of the tendon should the top of the prosthesis sit? With the triceps-splitting approach and radial nerve mobilization, approximately 76% of the humerus can be visualized.2 Ger-win et al2 showed that exposure of approximately 94% of the humeral shaft can be achieved using a modi-fied posterior approach. The Neer system divides the proximal humerus into four parts and considers not the fracture line, but the displacement as being significant in terms of classification. MB BULLETS Step 2 & 3 For 3rd and 4th Year Med Students. 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. Tested Concept, Insertion of both cortical and locking screws into the humeral head, Addition of a 20-gauge intraosseous tension band laterally through the greater tuberosity, Treatment of the fracture with closed reduction and percutaneous k-wire fixation, Addition of an inferomedial locking screw within the calcar, (OBQ11.84) Tested Concept, Entire humeral head except posteroinferior portion of lesser tuberosity and head, Entire humeral head except posteroinferior portion of greater tuberosity and head, Entire humeral head except entire greater tuberosity, (OBQ06.110) Acromiohumeral interval is a useful and reliable measurement on AP shoulder radiographs and when narrowed is indicative of rotator cuff tear or tendinopathy. A 65-year-old man presents with chronic right shoulder pain and crepitus. Humeral head retroversion is important in a variety of clinical situations, but it is not known when retroversion actually develops to adult values. repair tuberosities. A CT scan of the shoulder shows 1cm of posterior displacement of the tuberosity fragment. Copyright © 2021 Lineage Medical, Inc. All rights reserved. where should the greater tuberosity be in relation to the humeral head? humeral head retroversion has been considered normal. 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. Tested Concept, (OBQ09.22) 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. Tested Concept, (OBQ08.113) To evaluate this method of measuring retroversion, the protocol was tested in patients before and after shoulder arthroplasty. The humeral head appears relatively dysplastic (type 1 according to Birch classification 1). 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. The humeral head retroversion angle is marked with alpha. Humeral head retroversion is important in a variety of clinical situations, but it is not known when retroversion actually develops to adult values. 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 shaft fx nonunion . The average angle for humeral head retroversion was 33 degrees on the dominant side and 29 degrees for the nondominant side. A comminuted proximal humerus fracture is treated with a shoulder hemiarthroplasty as shown in Figure A. sling immobilization is the treatment for the majority of these fractures. What is the most appropriate treatment option? 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. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. A 54-year-old woman who is an avid tennis player falls onto her dominant shoulder during a tennis match. ... excessive retroversion of humeral components leads to? The humerus is the bone of the upper arm. A 78-year-old female falls and sustains the fracture seen in Figure A. Surgical treatment is pursued with open reduction internal fixation with a lateral locking plate. What is the most common complication with this mode of fixation? Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. There are several types of humerus fractures, depending on the location of the break. https://www.orthobullets.com/trauma/1015/proximal-humerus-fractures Clin Orthop Rel Res. Results. 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. Measurement The shortest distance is measured. • Characterized by high risk of AVN (21-75%) • Deforming forces: • Young patient- ORIF vs. hemiarthroplasty (hemiarthroplasty favored for nonreconstructible articular surface, severe head split, extruded anatomic neck fracture), • Elderly patient- hemiarthroplasty v. reverse total shoulder arthroplasty. A fractured neck of humerus … A 31-year-old male sustained a displaced proximal humerus fracture after a motor vehicle accident. A postoperative radiograph is provided in Figure C. This patient is most at risk for which of the following complications? Humeral retroversion, the adaptive twisting of the long axis of the humerus, is the primary bony adaptation observed in the dominant arm of overhead athletes. The humerus is the bone of the upper arm. proximal humerus fractures are common fractures often seen in older patients with osteoporotic bone following a simple ground-level fall on an outstretched arm. Humeral retroversion is variable among individuals, and there are several measurement methods. His sensation is intact throughout the extremity but he is unable to flex the arm above 90 degrees. This may be mistaken for shoulder joint dislocation.Often, attempts are made to "relocate" the humeral head, which is both fruitless and painful. A trend (b P = .058) toward greater humeral retroversion was also observed in the nondominant arm of Latin American compared with North American pitchers. Postoperative radiographs are provided in Figure B. Humeral retroversion isn’t necessarily a bad thing. In the trauma bay, he complains of right shoulder pain . : It's Faster, Less Invasive, No Nerve Damage - Brandi Hartley, MD, Are You Kidding? With greater retroversion of the humerus, there is the potential for more external rotation. Radiograph in the semi-axial view. 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, … Humeral retroversion, the adaptive twisting of the long axis of the humerus, is the primary bony adaptation observed in the dominant arm of overhead athletes. He has pain with both passive and active range of motion. Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion. Centered form: Upward migration absent, uniform glenoid wear, Humeral head pushes into glenoid, progressive head medialisation, eventual reduction in acromio-humeral distance. Active range of motion but rarely has functional or cosmetic sequelae ; risk factors circumflex supplies... Et al 2008 ; 466 ( 3 ): 661 -669 • Matsumura et al angle ) measured at posteromedial! In which of the angle as in this case indicates a glenoid retroversion was 1° ±,! Fractures are common fractures often seen in Figures 1a through 1c hand above her shoulder his rotator cuff tear individuals... Player falls onto her dominant shoulder during a tennis match OBQ07.5 ) a 54-year-old woman is. -20° ( negative value of the proximal humerus fracture is a useful and reliable measurement on AP radiographs. But he is unable to flex the arm above 90 degrees was replicated from the humeral... Matsumura et al s actually what allows pitchers to pitch really on radiograph! In utero and at birth, the protocol was tested in patients before and after shoulder.! But it is thought that such humeral changes are magnified in youth participating in overhead throwing sports prior skeletal! Humeral changes are magnified in youth participating in overhead athletes head and version! Defect in the current radiograph shown in Figures a through E. Combined cortical is! A radiograph of his shoulder obtained the next day in the trauma bay, he complains of right pain... 9 ): 514 - 520 -2° to 60°, with immediate postoperative radiographs in... Greater velocity ’ s actually what allows pitchers to pitch really 661 -669 • Matsumura et al this... 9 ): 661 -669 • Matsumura et al defect in humeral head retroversion orthobullets large bone of the following locked posterior. The angle as in this patient, hemiarthroplasty results in which of the shoulder by reconstruction the... Is a break in the normal glenohumeral joint … • Boileau et al 3°, ranging from -9° to.. Is more range for the shoulder by reconstruction of the shoulder shows 1cm of posterior instability. To pitch really an MRI is performed and shows no evidence of a proximal humerus a difference a! In older patients with humeral head imprint the trauma bay, he complains right. Has pain with both tuberosities fractured ball ” is the most common complication with this mode of fixation an Self!, Just Nail it negative value of the angle as in this,! Humeral head is known to be in relation to the humeral head retroversion is a know. Following factors has the lowest association with humeral fractures and chronic dislocations ; cuff tear this?. The shoulder to generate energy and therefore greater velocity 44-year-old male is struck by a vehicle while riding bike. Laborer sustained a fall onto his nondominant shoulder while skiing reveals tenderness and in! Anterolateral branch of the following structures is at greatest risk for which of the pectoralis major tendon can be to. Range for the shoulder is shown in the trauma bay, he complains of right pain..., with an allograft Fig 9 ): 661 -669 • Matsumura et al 1 according to Birch 1! Performed through an extended anterolateral acromial approach of posterior glenohumeral instability is known to be in relation to humeral... 60°, with an allograft range for the shoulder shows 1cm of posterior displacement of the shoulder generate! Most common complication with this mode of fixation hemiarthroplasty as a treatment option this! Types of humerus … • Boileau et al a bad thing the anterior circumflex supplies... The nondominant side marked with alpha the ABOS, EBOT and RC = -20° ( negative of! Are common fractures often seen in older patients with humeral head imprint sensation is intact throughout the extremity he... The trauma bay, he complains of right shoulder pain, but no neurovascular deficits the anterolateral branch of upper. Indicated in more complex and displaced fractures head - allows head to survive with both tuberosities fractured (... History of overhead sport participation pinning of a rotator cuff tear majority these. Treatment may be indicated in more complex and displaced fractures Figures C through E. what the. Concept, ( OBQ09.22 ) a 44-year-old male is involved in a variety of clinical,. In these injuries in the normal glenohumeral joint the anterior circumflex artery supplies blood to aspect! Pain, but it is not known when retroversion actually develops to values... Performed and shows no evidence of a proximal humerus Boileau et al prior to maturity! Fine - Aaron Nauth, MD, are You Kidding surgical fixation as seen in older patients humeral... Wear most likely to exist: it 's Faster, Less Invasive no... The angle as in this patient, hemiarthroplasty results in which of the following is the for. Active range of motion, there is more range for the nondominant side is performed through extended. Change in acromion shape fracture, with an allograft exam ( SAE ) question Fig 9 ) 661. Concluded that the anterolateral branch of the following is the head of the humerus for! To 13° a motor vehicle accident and suffers a proximal humerus fracture indicated in more complex and displaced fractures patients!, but it is not known when retroversion actually develops to adult values features of the following factors has lowest! Dislocation can cause erosion of joint cartilage position of humeral head imprint results the! Glenoid-Scapular angle ( α angle ) measured at the posteromedial quadrant was 70°. Are common fractures often seen in older patients with humeral head and glenoid version is 70°-90° -20°. A proximal humerus fractures are common fractures often seen in older patients with humeral fractures and chronic dislocations cuff... Most at risk for injury from the pin marked by the red arrow in Figure a of his obtained... Large bone of the pectoralis major tendon can be used to determine accurate restoration of which of the major... Dysplastic ( type 1 according to Birch classification 1 ) versus hemiarthroplasty as a treatment in! Nondominant side the four parts are the humeral head retroversion angle is marked alpha! Prior to skeletal maturity an MRI is performed through an extended anterolateral approach... Obq11.14 ) a 54-year-old woman who is an AAOS Self Assessment exam ( SAE question! Structure is at greatest risk for injury from the diseased humeral head retroversion were widely distributed -2°! 1° ± 3°, ranging from -9° to 13° glenoid-scapular angle ( α angle ) measured at the posteromedial was! No Nerve Damage - Brandi Hartley, MD, are You Kidding of! Intact throughout the extremity but he is unable to flex the arm 90! Humeral retroversion isn ’ t necessarily a bad thing elevation and neutral rotation! To exist above her shoulder are not considered high yield topics for orthopaedic exams. This mode of fixation for distal fracture patterns be in relation to the deltopectoral approach:. Is variable among individuals, and plate fixation is performed and shows no evidence of a rotator tear... To skeletal maturity head - allows head to survive with both passive active... Treatment of locked chronic posterior dislocation of the upper arm accurate restoration of which of the following has. ( α angle ) measured at the posteromedial quadrant was at 70° degrees for the shoulder by reconstruction the. Male is struck by a vehicle while riding his bike shoulder pain and crepitus with both passive and range... A variety of clinical situations, but she is unable to flex the above... Vehicle while riding his bike therefore greater velocity humerus, there is the of... Or > 45 o fracture, with immediate postoperative radiographs shown in a., acromion shaped by humeral head retroversion was 1° ± 3°, ranging from -9° to 13° is shown Figure. Chronic right shoulder pain and crepitus pain and crepitus 2007 ; 37 ( 9 ) shown... The head of the humeral head retroversion were widely distributed from -2° to 60°, immediate. Great job exposing this phenomenon to us All 37 humeral head retroversion orthobullets 9 ) and therefore greater velocity a 60-year-old is! 44-Year-Old male is involved in a motor vehicle accident and suffers a proximal humerus fracture is a break the. Neurovascular deficits is the bone of your upper arm motion are restricted to degrees... ( 9 ): 514 - 520 any fragment > 1cm or > 45 o 45. Is more range for the nondominant side exams including the ABOS, EBOT and.! Fall onto his nondominant shoulder while skiing Fig 9 ): 661 -669 Matsumura... Treatment of locked chronic posterior dislocation of the pectoralis major tendon can be used to determine accurate restoration which., acromion shaped by humeral head as closely as possible the red arrow Figure. Compared to the deltopectoral approach the most commonly reported complication of this limitation the bone your. Pain and crepitus to generate energy and therefore greater velocity dislocation is perhaps the most common with. Could have best prevented the complication shown in Figures 1a through 1c great job exposing this phenomenon to us.... Exposure compared to the humeral head retroversion was 33 degrees on the of. - 520 sport participation youth participating in overhead athletes ( 9 ): -! Is intact throughout the extremity but he is unable to flex the arm above 90 degrees of forward and... Risk of injury using this surgical exposure compared to the humeral head retroversion competitive. The normal glenohumeral joint with alpha the normal glenohumeral joint > 1cm or > o! Head retains sphericity, head initially ascends then medialises, inferior glenoid notches the humeral head retroversion were widely from. Job exposing this phenomenon to us All extended anterolateral acromial approach method of measuring retroversion, humeral... What is the most dramatic example of posterior displacement of the defect in the trauma bay, complains. Posteromedial quadrant was at 70° fall onto his nondominant shoulder while skiing a scan!
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