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. 2020 Oct 10;5(1):98-101.
doi: 10.1016/j.jseint.2020.08.016. eCollection 2021 Jan.

Humeral head subluxation in Walch type B shoulders varies across imaging modalities

Bogdan A Matache  1 , Naser Alnusif  2 , Jean Chaoui  3 , Gilles Walch  4 , George S Athwal  2
Affiliations

Humeral head subluxation in Walch type B shoulders varies across imaging modalities

Bogdan A Matache et al. JSES Int. .

Abstract

Background: The Walch type B pattern of glenohumeral osteoarthritis is characterized by posterior humeral head subluxation (PHHS). At present, it is unknown whether the percentage of subluxation measured on axillary radiographs is consistent with measurements on 2-dimensional (2D) axial or 3-dimensional (3D) volumetric computed tomography (CT). The purpose of this study was to evaluate PHHS across imaging modalities (radiographs, 2D CT, and 3D CT).

Methods: A cohort of 30 patients with Walch type B shoulders underwent radiography and standardized CT scans. The cohort comprised 10 type B1, 10 type B2, and 10 type B3 glenoids. PHHS was measured using the scapulohumeral subluxation method on axillary radiographs and 2D CT. On 3D CT, PHHS was measured volumetrically. PHHS was statistically compared between imaging modalities, with P ≤ .05 considered significant.

Results: The mean PHHS value for the entire group was 69% ± 24% on radiographs, 65% ± 23% with 2D CT, and 74% ± 24% with 3D volumetric CT. PHHS as measured on complete axillary radiographs was not significantly different than that measured on 2D CT (P = .941). Additionally, PHHS on 3D volumetric CT was 9.5% greater than that on 2D CT (P < .001). There were no significant differences in PHHS between the type B1, B2, and B3 groups with 2D or 3D CT measurement techniques (P > .102).

Conclusion: Significant differences in PHHS were found between measurement techniques (P < .035). A 9.5% difference in PHHS between 2D and 3D CT can be mostly accounted for by the linear (2D) vs. volumetric (3D) measurement techniques (a linear 80% PHHS value is mathematically equivalent to a volumetric PHHS value of 89.6%). Surgeons should be aware that subluxation values and therefore thresholds vary across different imaging modalities and measurement techniques.

Keywords: Posterior humeral head subluxation; Walch classification; Walch type B glenoid; glenohumeral osteoarthritis; linear subluxation; volumetric subluxation.

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Figures

Figure 1
Figure 1
Scapulohumeral subluxation method for calculating posterior humeral head subluxation. A best-fit circle is drawn on the humeral head, followed by a perpendicular tangent to the Friedman line at the location of maximal humeral head width; the percentage of posterior humeral head subluxation is obtained by dividing distance A by distance B.
Figure 2
Figure 2
Formula for calculating 3-dimensional volumetric posterior humeral head subluxation; a is the scapular axis line, h is the distance between the scapular axis line and the most posterior portion of the humeral head, and r is the radius.
See this image and copyright information in PMC

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