Ultrasonographic assessment of humeral retrotorsion in baseball players: a validation study

Am J Sports Med. 2012 May;40(5):1155-60. doi: 10.1177/0363546512436801. Epub 2012 Mar 1.


Background: Recently, clinicians and researchers started using diagnostic ultrasound to measure humeral torsion as an alternative to radiological assessments in overhead-throwing athletes and other clinical populations. Ultrasound appears to be a reliable, nonradiological alternative, but ultrasound assessment has not been validated against computed tomography (CT), the current gold standard.

Purpose: This study aimed to establish the validity of an ultrasound assessment of humeral torsion by comparing data obtained using both ultrasound and CT, the current standard.

Study design: Cohort study (Diagnosis); Level of evidence, 2.

Methods: Humeral torsion was measured using both ultrasound and CT in 24 collegiate-aged baseball players. Comparisons between the assessments were made using both regression and Bland-Altman plots. Reliability and precision were also established.

Results: A strong relationship existed between humeral torsion variables obtained with ultrasound and CT (R = .797, R (2) = .635, P < .001). The ultrasound assessment yielded reliability coefficients ranging from .991 to .997, with approximately 1° of measurement error. The CT method's reliability coefficients ranged from .805 to .933, with approximately 3.5° of measurement error.

Conclusion: There was a strong relationship between humeral torsion obtained with ultrasound and CT, the current standard of assessment. Ultrasound provides a reliable, valid alternative to CT for obtaining an indication of the amount of humeral torsion in the upper extremity.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Validation Study

MeSH terms

  • Adult
  • Baseball*
  • Bone Retroversion / diagnostic imaging*
  • Cohort Studies
  • Humans
  • Humerus / diagnostic imaging*
  • Humerus / pathology
  • Linear Models
  • Male
  • Observer Variation
  • Reproducibility of Results
  • Shoulder Joint / diagnostic imaging*
  • Shoulder Joint / pathology
  • Tomography, X-Ray Computed
  • Ultrasonography