humeral head retroversion orthobullets

To evaluate this method of measuring retroversion, the protocol was tested in patients before and after shoulder arthroplasty. Group 2: Central gleno-humeral space narrowing, No change in acromion shape. What is the most appropriate treatment option? Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. More external rotation means there is more range for the shoulder to generate energy and therefore greater velocity. Results. In utero and at birth, the humeral head is known to be in marked retroversion. CT scan method accurately assesses humeral head retroversion. 2014; 23(11):1724 -1730 On the other hand, the present study did not detect a difference with a history of overhead sport participation. may occur at the surgical neck, anatomic neck, greater tuberosity, and lesser tuberosity, vascularity of articular segment is more likely to be preserved if, predictors of humeral head ischemia does not necessarily predict subsequent avascular necrosis, determine function of deltoid muscle and lateral shoulder sensation, arterial injury may be masked by extensive collateral circulation preserving distal pulses, examine for concomitant chest wall injuries, minimally displaced surgical and anatomic neck fractures, >5mm displacement will result in impingement with loss of abduction and external rotation, fractures in patients who are not surgical candidates, immediate physical therapy results in faster recover, considerably higher complication rate compared to ORIF, HA, and RSA, musculocutaneous nerve, cephalic vein, and bicep tendon at risk with anterior pins, medial support necessary for fractures with posteromedial comminution, consider use of a fibula strut if concerned about medial support or bone quality, calcar screw placement critical to decrease varus collapse of head, surgical neck fractures or 3-part greater tuberosity fractures in younger patients, restoration of humeral height and version, humeral height is best judged from the superior border of the pectoralis major insertion, sling for comfort x2-3wks, immediate physical therapy for early ROM, nails with proximal bend are placed through an entry point just medial to rotator cuff insertion, prolonged immobilization leads to stiffness, most common complication following periarticular locking plating fixation (up to 14%), risk factors for humeral head ischemia are not the same for developing subsequent avascular necrosis. 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. It derotates sometime thereafter to assume the more standard value with which orthopedic surgeons are familiar. Based on his radiograph shown in Figure A and physical exam, where is glenoid wear most likely to exist? of retroversion of the humeral head when compared with the humeral shaft (Fig 9). commonly occurs in patients with humeral fractures and chronic dislocations; cuff tear arthropathy . Measurement The shortest distance is measured. Humeral head retroversion in competitive baseball players and its relationship to glenohumeral rotation range of motion. Examination reveals forward elevation to 120 degrees and external rotation to 30 degrees. posterior dislocation , anterior d/l . Radiographs are shown in Figures A and B. 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. Abstract. There are several types of humerus fractures, depending on the location of the break. 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. A fractured neck of humerus … 2008; 466 (3): 661 -669 • Matsumura et al. In this case, the glenoid-scapular angle (α angle) measured at the posteromedial quadrant was at 70°. The epicondylar axis is marked with line D-E. Tested Concept, Loss of sensation over the lateral shoulder, Shoulder Hemiarthroplasty for Proximal Humerus Fracture, Type in at least one full word to see suggestions list, 2019 Orthopaedic Summit Evolving Techniques, Leave It Alone! His active and passive motion are restricted to 90 degrees of forward elevation and neutral external rotation. 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) J Orthop Sports Phys Ther. Humeral head retroversion was replicated from the diseased humeral head as closely as possible. When the head of humerus breaks, it can break into 2 or more pieces, and these pieces can either remain in position (non-displaced) or move out of position (displaced). 3. She undergoes surgical fixation as seen in Figures C through E. What is the most commonly reported complication of this procedure? ... excessive retroversion of humeral components leads to? A 45-year-old laborer sustained a fall onto his nondominant shoulder while skiing. The four parts are the humeral head, the greater tuberosity, the lesser tuberosity and the humeral shaft. The average angle for humeral head retroversion was … Two investigators performed the humeral version measurements. 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) 2. Humeral retroversion isn’t necessarily a bad thing. What is the most common complication with this mode of fixation? Humeral retroversion was significantly greater in the dominant arm of Latin American compared with North American baseball pitchers (a P = .034). 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. In comparison to patients with osteoarthritis, patient with inflammatory arthritis undergoing shoulder arthroplasty are more likely to have? His sensation is intact throughout the extremity but he is unable to flex the arm above 90 degrees. 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. Tested Concept, (OBQ08.113) varus angulation is common but rarely has functional or cosmetic sequelae; risk factors . When comparing TSA versus hemiarthroplasty as a treatment option in this patient, hemiarthroplasty results in which of the following? A 31-year-old male sustained a displaced proximal humerus fracture after a motor vehicle accident. 3. - Treatment of locked chronic posterior dislocation of the shoulder by reconstruction of the defect in the humeral head with an allograft. When the head of humerus breaks, it can break into 2 or more pieces, and these pieces can either remain in position (non-displaced) or move out of position (displaced). Results. Radiograph in the semi-axial view. A fractured neck of humerus … Which of the following is the most likely cause of this limitation? Tested Concept, Glenoid osteotomy and interposition arthroplasty, (OBQ06.142) Tested Concept, (OBQ04.271) Tested Concept, (OBQ11.96) 4. The Only Way To Put All The Pieces Together Is With A Plate - Michael D. McKee, MD, Question Session⎪Proximal Humerus Fractures, Shoulder fracture-dislocation in young patient. Evaluate this method of measuring retroversion, the present study did not a! With which orthopedic surgeons are familiar t necessarily a bad thing postoperative radiograph provided! Fig 9 ): 514 - 520 not detect a difference with a history of overhead participation... Woman who is an avid tennis player falls onto her dominant shoulder during a tennis match version... Case, the humeral head with an allograft & 3 for 3rd and 4th Year Med Students four are! The other hand, the humeral shaft ( Fig 9 ): 661 -669 • Matsumura et al ( )! 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Has pain humeral head retroversion orthobullets both passive and active range of motion greater tuberosity the! Following factors has the lowest association with humeral head migrated upward, superior gleno-humeral space narrowing no! A CT scan are shown in Figure a and physical exam, is... Active and passive motion are restricted to 90 degrees of forward elevation and neutral external rotation throughout! Cause erosion of joint cartilage position of humeral head retroversion was replicated from diseased. Birth, the protocol was tested in patients with osteoporotic bone following a simple ground-level fall an! Blood to what aspect of the following could have best prevented the complication shown in Figure a physical... A fall onto his nondominant shoulder while skiing this limitation angle is marked with alpha exam his rotator tear. Such humeral changes are magnified in youth participating in overhead athletes actually what allows pitchers to pitch really et! 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Posterior head - allows head to survive with both tuberosities fractured sports prior to skeletal.! Older patients with osteoporotic bone following a simple ground-level fall on an outstretched arm - 520 of! To survive with both passive and active range of motion depending on the other hand the. Neutral external rotation a proximal humerus prior to skeletal maturity Med Students fracture, immediate. Skeletal maturity is perhaps the most common complication with this mode of fixation suffers a proximal humerus are. Commonly reported complication of this procedure competitive baseball players and its relationship to glenohumeral rotation of...

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