Figure 1. Equipment for sonographically assisted measurement of humeral torsion.

Figure 2. Sonographically assisted indirect measurement of humeral torsion. The angles determined are each given a positive sign if the corresponding protractor is inclined inward/caudal during the measurement and a negative sign if the protractor is inclined outward/cranial during the measurement. As the corresponding protractor attached to the transducer is inclined outward/cranial in this case, a negative sign must be given to this determined angle. As also the vertically positioned forearm protractor was zeroed on the horizontal table plane before attachment, its measured angle has to be subtracted from 90° to obtain the actual forearm angle. In this case, the forearm protractor displayed 65.01°, which results in 24.99° as actual forearm angle (90°–65.01°). All values were rounded for further calculation.

Figure 2. Sonographically assisted indirect measurement of humeral torsion. The angles determined are each given a positive sign if the corresponding protractor is inclined inward/caudal during the measurement and a negative sign if the protractor is inclined outward/cranial during the measurement. As the corresponding protractor attached to the transducer is inclined outward/cranial in this case, a negative sign must be given to this determined angle. As also the vertically positioned forearm protractor was zeroed on the horizontal table plane before attachment, its measured angle has to be subtracted from 90° to obtain the actual forearm angle. In this case, the forearm protractor displayed 65.01°, which results in 24.99° as actual forearm angle (90°–65.01°). All values were rounded for further calculation.

Figure 3. Greater and lesser tuberosities are displayed horizontally in one plane with the aid of a film with horizontal parallel lines attached to the screen of the ultrasound device.

Figure 4. Humeral torsion, retrotorsion, and sonographic torsion in a right humerus.

Figure 5. Case study: Active range of rotational motion of the unaffected shoulder.

Figure 6. Case study: Active range of rotational motion of the affected shoulder.

Table 1. Case report: Passive range of rotational motion in 90° of shoulder abduction.

Table 1. Case report: Passive range of rotational motion in 90° of shoulder abduction.

Case Study: Passive Range of Rotational Motion in 90° Abduction Internal rotation (in degrees [°])External rotation (in degrees [°])Left arm (unaffected)65°100°Right arm (affected)0°140°

Table 2. Different sonographic torsion measurements in previous literature.

Table 2. Different sonographic torsion measurements in previous literature.

Different Sonographic Torsion Measurements in Previous LiteratureAuthorYearnTorsion Angle (in degrees [°])
Mean ± Standard Deviation (Range)JournalDetermining the torsion angle using the forearm and measuring the angles
in relation to a vertical reference axisIto et al. [6]19953015.1 ± 3.9 (right) ± 2.9 (left)J. Shoulder Elbow Surg.Whiteley et al. [11]20063218.2 ± 9.6 (4 to 40) (dominant)
19.8 ± 10.8 (5 to 45) (nondominant)J. Sci. Med. SportWhiteley et al. [11]20067013.8 ± 8.6 (−3 to 36) (dominant)
25 ± 9.2 (8 to 50) (nondominant)J. Sci. Med. SportThomas et al. [14]2012480.53 ± 12.53 (dominant)
16.13 ± 11.53 (nondominant)J. Shoulder Elbow Surg.Shanley et al. [15]20126610 ± 11 (dominant)
23 ± 11 (nondominant)J. Shoulder Elbow Surg.Noonan et al. [16]201532410.4 ± 11.7 (dominant)
22.7 ± 11.7 (nondominant)Am. J. Sports Med.Achenbach et al. [12]201927616.5 ± 9.6 (dominant)
13.5 ± 9.4 (nondominant)Knee Surg. Sports Traumatol. Arthrosc.Yaari et al. [13]20204020 ± 10 (dominant)
29 ± 12 (nondominant)Int. J. Sports Phys. Ther.Determining the torsion angle using the forearm and measuring the angles
in relation to a horizontal reference axisMyers et al. [8]20122474.2 ± 14.5 (dominant)
61.2 ± 14.4 (nondominant)Am. J. Sports Med.Saka et al. [9]20152878.5 ± 7.9 (dominant)
70.1 ± 7.8 (nondominant)Orthop. J. Sports Med.Hannah et al. [10]20183064.4 ± 9.5J. Athl. Train.Sonographic measurement of retroversion according to HarlandJerosch et al. [37]19892067.85 ± 7.1 (52 to 80)Ultraschall Med.Harland et al. [4]19912070.65 ± 8.4 (52 to 86)Z. Orthop.Harland et al. [4]199111160.9Z. Orthop.Kunz et al. [34]19934052.0 ± 13.1 (24 to 75)Z. Orthop.