Conventional Humeral Retroversion Measurements Using Computed Tomography Slices or Ultrasound Images Are Not Correlated With the 3-Dimensional Humeral Retroversion Angle

Background: Humeral retroversion angles determined by previous techniques are varied and/or biased by morphologic variations of the proximal and distal humerus, and their validity should be revisited. To overcome the limitations of previous studies associated with 2-dimensional (2D) images and the reference axes, a 3-dimensional (3D) measurement of humeral retroversion is required. However, comparisons of 2D imaging methods with the 3D computed tomography (CT) measurement as a reference standard have not been heretofore performed. Purpose: To determine whether the 3D CT humeral retroversion angle in baseball players is correlated with conventional humeral retroversion measurements. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 28 humeri from 14 male baseball players were used for measuring humeral retroversion. Participants underwent CT scans, and geometric bone models were created for measuring the 3D CT humeral retroversion angle. Using CT slices, the 2D CT humeral retroversion angle was also determined. Bicipital forearm angle was assessed using the indirect ultrasound technique. Linear regressions and Bland-Altman plots were used to determine whether there were agreements among 3 variables: the 3D CT retroversion, 2D CT retroversion, and bicipital forearm angles. Results: In linear regression analyses, the 3D humeral retroversion angle was not predicted by the 2D CT retroversion (R = 0.167, R-2 = 0.028, P = .395) or the bicipital forearm angle (R = 0.049, R-2 = 0.002, P = .805). The bias of these 2 methods was 20.9 degrees and -15.3 degrees, respectively. Regression analysis demonstrated that the bicipital forearm angle was a significant predictor of the 2D CT retroversion angle (R = 0.632, R-2 = 0.400, P < .001). Conclusion: The 3D CT humeral retroversion angle was found to be underestimated by the 2D CT retroversion angle and overestimated by the bicipital forearm angle obtained by the indirect ultrasound, although a previously observed relationship between the 2D CT retroversion and bicipital forearm angles was confirmed. Clinical Relevance: Precise measurement of humeral retroversion angle is important because retroversion has been linked to upper extremity disorders, including throwing-related shoulder and elbow disorders in baseball players.