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Relationship of Bicipital Groove Rotation with Humeral Head RetroversionA Three-Dimensional Computed Tomographic Analysis
Jeff W. Johnson, MD1; Jeff D. Thostenson, MS1; Larry J. Suva, PhD1; S. Ashfaq Hasan, MD2
1 Departments of Orthopaedic Surgery (J.W.J. and L.J.S.) and Biostatistics (J.D.T.), University of Arkansas for Medical Sciences, 4301 West Markham, Slot 531, Little Rock, AR 72205
2 Department of Orthopaedics, University of Maryland, 2200 Kernan Drive, Suite 1154, Baltimore, MD 21207. E-mail address: ahasan@umoa.umm.edu
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Investigation performed at the University of Arkansas for Medical Sciences, Little Rock, Arkansas

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Apr 17;95(8):719-724. doi: 10.2106/JBJS.J.00085
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Bicipital groove location has been used as a reference for humeral stem orientation in total shoulder arthroplasty to recreate humeral head retroversion. However, anatomic variability has rendered its use for prosthetic orientation problematic in cases of comminuted proximal fractures. We hypothesized that variability in groove rotation is directly related to variability in humeral head retroversion and that by defining the degree of groove rotation, humeral head retroversion can be predicted.


Computed tomographic scans (1-mm sections) were obtained along the entire lengths of thirty-four cadaveric humeri, and three-dimensional models were created by using computer-assisted design software. Humeral head retroversion was determined in reference to the transepicondylar axis. The bicipital groove was mapped from proximal to distal, and the rotation of the groove in relationship to the transepicondylar axis was tracked over the entire length of the groove. The overall groove rotation and the rotation of its proximal, intermediate, and distal 15-mm segments were determined.


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. Pearson correlation coefficients between bicipital groove rotation and humeral head retroversion were ≥0.78 for all segments.


A previously unknown direct correlation between bicipital groove rotation and humeral head retroversion was found to exist. The ability to predict humeral head retroversion when mapping only the distal third of the groove has potentially important clinical implications because the distal third is often the only portion of the groove remaining in patients with a comminuted proximal humeral fracture. This is particularly relevant with computer-navigated surgery.

Clinical Relevance: 

Improved understanding of the anatomic variability of the proximal part of the humerus may ultimately allow improved patient-specific reconstruction after shoulder arthroplasty for fracture.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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