ArticlePDF Available

THE CARRYING ANGLE OF ELBOW-A CORRELATIVE AND COMPARATIVE STUDY

Authors:
  • Tomo Riba Institute of Health and Medical Sciences

Abstract

Background and Objectives: The angle formed by the axes of the arm and the axes of forearm when the elbow is fully extended and forearm is supinated that obtuse angle is known as " carrying angle ". Carrying angle evaluation is important to identify deformities of elbow. The present study aimed Measure and correlation of carrying angle with various parameters in young males and females. Materials and methods: The present study includes 220 (110 females & 110 males) healthy students of MBBS from KBNIMS, Gulbarga, belongs to Karnataka were selected and ages groups is 18 to 22 years. Goniometry is used for measurement of carrying angle. Height measured in normal anatomical standing posture and length of forearm measured with measuring tape. Measurements were documented and statistically analyzed. Spearman's correlation use to get relationship between parameters. Result: In females there was a significant positive correlation (p<0.05) of age with carrying angle of both sides, height was negatively correlated with carrying angle of both sides, no correlation between length of forearm with coring angle. In males Age and Height were not correlated with carrying angle but, the length of the forearm was significantly negatively correlated with carrying angle of both sides (p<0.05). Greater carrying angle was found in females. Conclusion: Carrying angle increases with age and greater in females may be because Olecranon‐coronoid angle exhibiting high sexual dimorphism may be one of the causes and it may also considered as secondary sexual characteristic. Carrying angle measurement helpful in reconstruction of elbow disorders observed after treatment of distal humerus fractures and evaluating praumatic elbow injuries.
Jyothinath Kothapalli et al
THE CARRYING ANGLE OF ELBOW- A CORRELATIVE AND COMPARATIVE STUDY
Int J Cur Res Rev, Apr 2013/ Vol 05 (07)
Page 71
IJCRR
Vol 05 issue 07
Section: Healthcare
Category: Research
Received on: 25/02/13
Revised on: 16/03/13
Accepted on: 05/04/13
THE CARRYING ANGLE OF ELBOW- A CORRELATIVE AND
COMPARATIVE STUDY
Jyothinath Kothapalli1, Pradeepkumar H. Murudkar1, Lalitha Devi Seerla2
1Department of Anatomy, Khaja Bandanawaz Institute of Medical Sciences, Gulbarga,
Karnataka, India
2Department of Biochemistry, Bidar Institute of Medical sciences (Govt. of Karnataka),
Bidar, Karnataka, India
E-mail of Corresponding Author: kjyothinath@gmail.com
ABSTRACT
Background and Objectives: The angle formed by the axes of the arm and the axes of forearm when
the elbow is fully extended and forearm is supinated that obtuse angle is known as “carrying angle”.
Carrying angle evaluation is important to identify deformities of elbow. The present study aimed
Measure and correlation of carrying angle with various parameters in young males and females.
Materials and methods: The present study includes 220 (110 females & 110 males) healthy students
of MBBS from KBNIMS, Gulbarga, belongs to Karnataka were selected and ages groups is 18 to 22
years. Goniometry is used for measurement of carrying angle. Height measured in normal anatomical
standing posture and length of forearm measured with measuring tape. Measurements were
documented and statistically analyzed. Spearman’s correlation use to get relationship between
parameters.
Result: In females there was a significant positive correlation (p<0.05) of age with carrying angle of
both sides, height was negatively correlated with carrying angle of both sides, no correlation between
length of forearm with coring angle. In males Age and Height were not correlated with carrying angle
but, the length of the forearm was significantly negatively correlated with carrying angle of both sides
(p<0.05). Greater carrying angle was found in females.
Conclusion: Carrying angle increases with age and greater in females may be because
Olecranoncoronoid angle exhibiting high sexual dimorphism may be one of the causes and it may also
considered as secondary sexual characteristic. Carrying angle measurement helpful in reconstruction of
elbow disorders observed after treatment of distal humerus fractures and evaluating praumatic elbow
injuries.
Keywords: Carrying angle, Elbow joint. Sexual dimorphism, Trochlear angle
INTRODUCTION
The elbow joint is formed between the humerus
in the upper arm and the radius and ulna in the
forearm and allows the hand to be moved towards
and away from the body. When the arm is
extended forward, the humerus and forearm are
not perfectly aligned a deviation occurs laterally
towards the long axis of the arm, which is
referred as the "carrying angle" (1).
The carrying angle apparently develops in
response to pronation of the forearm and keeps
the swinging upper extremity away from the side
of the pelvis during walking (2). William et al
suggested that the angle is formed by the medial
edge of trochlea of humerus partly projects nearly
6 mm below the lateral edge & the oblique
superior articular surface of the coronoid process
which is not set at right angle to the shaft of ulna
Jyothinath Kothapalli et al
THE CARRYING ANGLE OF ELBOW- A CORRELATIVE AND COMPARATIVE STUDY
Int J Cur Res Rev, Apr 2013/ Vol 05 (07)
Page 72
(3). Some studies showed that the inner lip of
trochlea of humerus is a ridge groove deeper in
distally anteriorly so ulna is deflected in full
extension by this ridge (4, 5).
Women on average have smaller shoulders and
wider hips than men, which may be one reason
for more acute carrying angle. A more recent
study based on a sample size of 333 individuals
from both sexes concluded that carrying angle is
a suitable secondary sexual characteristic. The
olecranon- coronoid angle shows high sexual
dimorphism and it may be one of the causes of
sexual difference observed in carrying angle (6).
The evaluation of carrying angle is also essential
for handling and monitoring of traumatic lesions
that affect the pediatric elbow (7). The increased
carrying angle may lead to elbow instability and
pain during exercise or in throwing sports and
may reduce elbow flexion, dislocation, fracture
when fall on outstretched hand and fracture of
distal humeral epiphysis (8, 9, 10) and also
important anthropologically for sex
differentiation in skeletal remains and reduction
of fractures complication of supracondylar
fracture and may result in cosmetic deformity and
for designing total elbow prosthesis (23).
Hence, the present study aimed to study the
difference in carrying angle between sex (i.e.,
Male & female) and to find out any correlation of
carrying angle with different parameters like age,
height, length of the fore arm as this helps
orthopedic surgeon for correction of cubitus
varus deformity occurring after malunited
supracondylar fracture of humerus.
MATERIAL AND METHODS
After informed consent, 220 (110 female & 110
male) asymptomatic, healthy students of M.B.B.S
of Khaja Bandanawaz institute of Medical
sciences, Gulbarga belonging to various regions
of Andhra Pradesh, Karnataka were recruited for
the study. There ages ranged between 18 to 22
years. Medical students of this age group were
selected as subject because of easy availability.
Demographical data was obtained from each
subject including age. The students who had
previous elbow injuries as well as congenital
anomalies about the elbow were excluded from
study. The study was designed to include subjects
criteria was those with asymptomatic of any
deformity, surgeries or fractures around the
elbow joint and right handed individuals.
An improvised instrument goniometry was used
to measure the carrying angle from both upper
limbs of right and left side. The fixed arm placed
on the median axis of the upper arm, the movable
arm adjusted as to lie on the median axis of
forearm and the angle read on the goniometer.
Height was measured in standing, erect,
anatomical position from vertex to heel with bare
foot. Measuring tape was used to measure the
length of forearm and technique used for
measuring carrying angle is universally accepted.
Measurements were documented and statistical
analysis was done to get mean, and spearman’s
correlation Analysis was done to determine any
possible relationship between age, height and
length of forearm with carrying angle.
RESULTS
Table: 1 shows there was a significant difference
in carrying angle of the two sides of the upper
limbs both in males and females and a significant
greater carrying angle was found in females. It
was observed that the carrying angle of right limb
was greater than left in both sexes. Similarly the
right length of the forearm was significant than
the left in both males and females.
In the present study we have done spearmen’s
correlation analysis to observe relationship
between various parameters in both sexes.
Table: 2 shows there was a significant positive
correlation (p<0.05) of age with carrying angle of
both sides in females. Height was negatively
correlated with carrying angle of both sides but
not significant similarly there was no correlation
between length of forearm with carrying angle in
females.
Jyothinath Kothapalli et al
THE CARRYING ANGLE OF ELBOW- A CORRELATIVE AND COMPARATIVE STUDY
Int J Cur Res Rev, Apr 2013/ Vol 05 (07)
Page 73
In Males Age and Height were not correlated
with carrying angle but, the length of the forearm
was significantly negatively correlated with
carrying angle of both sides (p<0.05) shown in
Table: 3.
DISCUSSION
Apes and humans are distinguished from other
primate species in possessing carrying angle at
the elbow. The evolution of a carrying angle in
apes is related to the need to bring the center of
mass of the body beneath the supporting hand
during suspensory locomotion as seen in lower
limbs of humans in which the valgus knee brings
the foot nearer the center of mass of the body
during the single limb support phase of walking
(11).
In the present study we observed that carrying
angle of females (13.54±6.44) is greater than
males (12.09±4.66) our study was in line with
studies like Khare GN et al (12) showed that
carrying angle was more in females and they
concluded that the carrying angle does not help in
keeping the forearm away from the side of pelvis
during walking, the forearm is pronated and
carrying angle disappears in pronation of
forearm. Fick (13) claimed that the external
deviation of the forearm is because of two
powerful muscles brachioradialis and extensor
carpi radialis longus. These muscles as they
located at the radial side abduct the forearm
radially and contribute to the formation of the
carrying angle. This ‘‘muscular theory’’ explains
carrying angle fact that (a) in individuals of
athletic and obese constitution, the angle is more
as the muscles are well developed, and (b) in
older individuals the angle is more as muscles
are stronger. But, in many cases, the muscular
theory cannot explained like the carrying angle is
more obvious in women, in whom the muscles
are less developed than in men. This may be
inferior one-third of the shaft of the female
humerus appears to have a slight radial deviation,
which causes a more carrying angle in women
(14). Aebi et al, Paraskevas G et al. (15,16)
concluded that the brachial angle is similar in
both sexes, but the ulnar angle of the elbow joint
is smaller in women than in men, which causes a
more carrying angle in women. Hubscher (14)
noted that the angle is very similar in boys and in
men, but varies in females with age, he explained
that the hormonal factor may influence the
carrying angle in women. Emami et al &
Tukenmez et al (17, 18) found that carrying angle
increases with age because of skeletal maturation
and it is always greater on dominant side.
Our study was in contrast with studies like Beals
et al (19) carrying angle increases with age, but
same in each gender, but the study was done
radiographically. Similarly, Dai et al (20) did not
find any difference in carrying angle between
boys and girls this variability may be because of
different measurement techniques, races and
number of cases.
Hence, Most of the studies have focused on cause
of formation of carrying angle, difference in sex
and age but little attention has given to correlate
the carrying angle with various parameters. In the
present study we made an effort to find out the
correlation of carrying angle with age, height and
length of forearm and found that in females the
carrying angle significantly positively correlated
with age, negatively but not significantly
correlated with height and no correlation was
found with length of forearm. In males the
carrying angle was correlated with age and height
but, negatively significantly correlated with
length of forearm.
Our study was in agreement with study of
Ruparelia et al (21) found that the height and
forearm length both are more in males than
females. In contrast to this average carrying angle
is more in females than males, the findings
similar to present study they explained that if
height & length of ulna is lesser then in shorter
person the medial part of trochlear notch of ulna
goes more away from the medial flange of
trochlea which can now grow more than in a
Jyothinath Kothapalli et al
THE CARRYING ANGLE OF ELBOW- A CORRELATIVE AND COMPARATIVE STUDY
Int J Cur Res Rev, Apr 2013/ Vol 05 (07)
Page 74
person with longer forearm, leading to greater
carrying angle.
In present study in females there was no
relationship of carrying angle with forearm length
and in males the forearm length increases the
carrying angle decreases we proposed an
explanation that the carrying angle depend on
greater the length of the forearm bone lesser is
the angulation of proximal articulation of
proximal articular surface, therefore lesser is the
carrying angle. Shorter persons therefore have
smaller carrying angles than taller persons.
The study of carrying angle has much clinical
significance like extent of the carrying angle is
used to determines the type of fracture that a
child suffers when falling on an outstretched hand
and also cubitus varus deformity can be
prevented. The increased carrying angle may also
leads to ulnar neuropathy. First, is it increase
angulation of the ulnar nerve pathway and
increase the tension & chronic stretching injury
of the ulnar nerve at the elbow. Second, the ulnar
nerve is angulates two heads of the flexor carpi
ulnaris muscle by forward movement of the ulnar
nerve resulting from forward movement of the
medial head of the triceps brachii muscle in
patients with cubitus valgus or cubitus varus
deformity (22).
CONCLUSION
In our results are consistent with the literature
that the carrying angle increases with age and
carrying angle is greater in females because
Olecranoncoronoid angle exhibiting high sexual
dimorphism may be one of the causes of sexual
dimorphism observed in carrying angle and it
may be considered as secondary sex
characteristic in female. The highest value of this
angle in the female gender would be justified by
the presence of ligamentous laxity also.
Knowledge of the measurement of the elbow
carrying angle and of its variations is important
when evaluating traumatic elbow injuries in
childhood and in adolescence and other elbow
disorders that require reconstruction or
arthroplasties. Increased carrying angle may be a
risk factor for nontrauma- related ulnar
neuropathy.
ACKNOWLEDGEMENT
All the authors are thankful to Miss. J.
Ratnapriyanka for her support. We are also
thankful to Mr. Md Shahid and students of
MBBS of KBNIMS for his help. Authors also
acknowledge the immense help received from the
scholars whose articles are cited and included in
references of this manuscript. The authors are
also grateful to authors / editors / publishers of all
those articles, journals and books from where the
literature for this article has been reviewed and
discussed.
REFERENCES
1. Snell RS. Clinical Anatomy, 7th ed.
Philadelphia, PA: Lippincott Williams &
Wilkins; 2004:551.
2. Khare GN, Goel SC, Saraf SK, Singh G,
Mohanty C. New observations on carrying
angle. Indian J Med Sci. 1999; 53:6167.
3. Williams A, Standring S, Ellis H, Haely J
2005 Gray’s Anatomy.
4. Last RJ 1978 Anatomy regional and
applied 6th edn London. Churchill
Livingstone Longman.
5. Decker Gog 1986 Lee Mce Gregor’s synopsis
of Surgical Anatomy 12th Edn. Bristol : John
Wright and Sons Ltd.
6. Purkait R, Chandra H, An anthropometric
investigation into the probable cause of
formation of carrying angle: a sex indicator,
Journal of Indian Academy of Forensic
Medicine, 2004, 26(1):1923.
7. Balasubramanian P, Madhuri V, Muliyil J.
Carrying angle in children: a normative
study. J PediatrOrthop B. 2006;15:37-
40.Punia Rs, Sharma R, Usmani Ja, The
carrying angle in an Indian population, J Anat
Soc India, 1994, 43(2):107110.
Jyothinath Kothapalli et al
THE CARRYING ANGLE OF ELBOW- A CORRELATIVE AND COMPARATIVE STUDY
Int J Cur Res Rev, Apr 2013/ Vol 05 (07)
Page 75
8. Cain EL Jr, Dugas JR, Wolf RS, Andrews JR.
Elbow injuries in throwing athletes: a current
concepts review. Am J Sports
Med.2003;31:621635.
9. Hutchinson MR, Wynn S. Biomechanics and
development of the elbow in the young
throwing athlete. Clin Sports Med. 2004;
23:531544.
10. Van Roy P, Baeyens JP, Fauvart D, Lanssiers
R, Clarijs JP. Arthro-kinematics of the elbow:
study of the carrying angle. Ergonomics.
2005; 48:16451656.
11. Ćwirko-Godycki M, Sexing skeletal remains.
In: Krogman Wm (Ed), The human skeleton
in forensic medicine, 3rd edition, Charles C
Thomas, Illinois, 1978, 112152.
12. Khare Gn, Goel Sc, Saraf Sk, Singh G,
Mohanty C, New observations on carrying
angle, Indian J Med Sci, 1999, 53(2):6167.
13. Fick R (1911) Handbuch der Anatomie und
Mechanik der Gelenke. Fischer, Jena
14. Hubscher C (1899) Der Ellbogenwinkel.
Dtsch Z Chir 53:445
15. Aebi H (1947) Der Ellbogenwinkel, seine
Beziehungen zu Geschlecht, Korperbau und
Huftbreite. Thesis, University of Basle
16. Paraskevas G, Papadopoulos A, Papaziogas
B, Spanidou S, Argiriadou H, Gigis J, Study
of the carrying angle of the human elbow
joint in full extension: a morphometric
analysis, Surg Radiol Anat, 2004, 26(1):19
23.
17. M.j. Emami, f. Abdinejad, s. Khodabkhshi,
m. Amini, Andb. Naseri the normal carrying
angle of the elbow. In shiraz mjiri, 1998, 12
(1):37-39.
18. Mehmet Tukenmez, Huseyin Demirel, Sitki
Percin, Gunduz Tezeren. Measurement of the
carrying angle of the elbow in 2,000 children
at ages six and fourteen years. Acta orthop
Traumatol Turc 2004, 38 (4): 274-276.
19. Beals RK. The normal carrying angle of the
elbow. A radiographic study of 422 patients.
Clin Orthop 1976; (119):194-6.
20. Dai L. Radiographic evaluation of Baumann
angle in Chinese children and its clinical
relevance. J Pediatr Orthop B 1999; 8:197-9.
21. Srushti Ruparelia, Shailesh Patel, Ankur
Zalawadia, Shaival Shah, S. V. Patel. Study
Of Carrying Angle And Its Correlation With
Various Parameters. NJIRM 2010; 1(3):28-
32.
22. Hui JH, Torode IP, Chatterjee A. Medial
approach for corrective osteotomy of cubitus
varus: a cosmetic incision. J Pediatr Orthop.
2004; 24:477481.
23. Punia Rs, Sharma R, Usmani Ja, The carrying
angle in an Indian population, J Anat Soc
India, 1994, 43(2):107110.
Table: 1 Shows Demographic values and carrying angle of both sexes
side
Carrying angle
(in degree)
Length of forearm
(in cm)
Height (in cm)
Age
Range
Mean±SD
Range
Mean±SD
Range
Mean±SD
Range
Mean±SD
Right
5-22
12.09±4.66
25-31
28.07±1.48
164-188
172.83±6.75
18-22
19.89±1.36
Left
5-19
10.20±4.53
25-30
27.97±1.35
Right
4-27
13.54±6.44
23-29.5
26.12±1.45
148-170
159.18±6.42
18-22
19.88±1.37
Left
4-25
11.90±5.61
23-29
25.81±1.57
Jyothinath Kothapalli et al
THE CARRYING ANGLE OF ELBOW- A CORRELATIVE AND COMPARATIVE STUDY
Int J Cur Res Rev, Apr 2013/ Vol 05 (07)
Page 76
Table-2 Spearman’s correlation coefficient Analysis of female group:
Variables
CORRELATION COEFFICIET (ρ)
p VALUE
Age and carrying angle of right
0.249**
0.05*
Age and carrying angle of left
0.247**
0.04*
Height and carrying angle of right
-0.083
0.38
Height and carrying angle of left
-0.057
0.55
Forearm length of right and carrying angle of right
0.188
0.49
Forearm length of left and carrying angle of left
0.216
0.23
* - Statistically significant, ρ = spearman’s correlation coefficient
Table-3 Spearman’s correlation coefficient Analysis of Male group:
Variables
CORRELATION COEFFICIET (ρ)
p VALUE
Age and carrying angle of right
0.017
0.85
Age and carrying angle of left
0.072
0.45
Height and carrying angle of right
0.014
0.88
Height and carrying angle of left
-0.030
0.75
Forearm length of right and carrying angle of right
-0.199*
0.03*
Forearm length of left and carrying angle of left
-0.198*
0.03*
* - Statistically significant, ρ = spearman’s correlation coefficient
... Several studies have investigated the relationship between carrying angle and age [5,6], sex [6], dominant side [4,12], body characteristics such as trans-trochanteric diameter [4], height [12], length of the forearm [13], length of the arm [14] constitution [4], race, and inter-epicondylar distance [15]. A study done on healthy Chinese children reported a negative correlation between Baumann's angle and carrying angle [16]. ...
... The CCA was measured as the angle between the central axis of the forearm and arm. The central axis of the forearm was taken as a line joining the midpoint of the inter-epicondylar line to the midpoint of the inter-styloid line at the wrist [13]. The central axis of the arm was taken as a line joining the midpoint of the inter-epicondylar line to the tip of the acromion process of the arm [13]. ...
... The central axis of the forearm was taken as a line joining the midpoint of the inter-epicondylar line to the midpoint of the inter-styloid line at the wrist [13]. The central axis of the arm was taken as a line joining the midpoint of the inter-epicondylar line to the tip of the acromion process of the arm [13]. RCA was measured on a true anteroposterior (AP view of the X-ray of the elbow by measuring the angle between the longitudinal axis of the humeral shaft and the longitudinal axis of the shaft of the ulna [18][19][20]. ...
Article
Purpose This prospective cohort study aims to determine the factors that are associated with the carrying angle of the human elbow in the pediatric age group. Methods One hundred forty children up to 15 years of age were assessed for age, sex, forearm lengths of both sides, arm length of both sides, trans-trochanteric diameter, height, BMI, the inter-epicondylar distance of both sides, Baumann's angle of both sides, presence or absence of secondary sexual characteristics, clinical carrying angle (CCA) of both sides, and radiological carrying angle (RCA) of both sides. Unpaired t-test was used to compare the means of carrying angle in the unrelated groups, namely gender and secondary sexual characteristics. The strength and direction of the relationship between carrying angle and continuous variables were tested by calculating Pearson's correlation. Variables found to be associated with carrying angle at significance level >0.25 on bi-variable analysis were used to design a linear regression model to identify factors associated with carrying angle. Results The mean age was 5.84±4.76 years. Ninety-eight (70%) were males, and forty-two (30%) were females. The mean CCA on the right side was 8.55±2.01. The mean CCA on the left side was 8.77±2.03. The mean RCA on the right side was 8.85±2.09. The mean RCA on the left side was 9.07±2.13. On bi-variable analysis, the CCA was found to be associated with age, secondary sexual characteristics, weight, height, arm length, forearm length, inter-epicondylar distance, trans-trochanteric distance, and Baumann's angle. CCA was found to be significantly negatively correlated with BMI. On multivariate linear regression, the CCA was found to be associated with age and inter-epicondylar distance. Conclusion Age and inter-epicondylar distance are the true associations of carrying angle.
... It is also reported that the carrying angle may be affected by genetic diseases related to sex chromosomes [3,4]. Some studies reported that the carrying angle was greater on the right elbow [7,11,15]. However, some literature indicated that there was no difference between the carrying angle on the both sides [2,10,12,18]. ...
... In previous studies, the carrying angle was studied on postnatal period from infancy to adulthood [2,6,7,10,11,16,18]. The results of some previous studies are shown with our results (Table 5). ...
... There are numerous studies reported that the carrying angle values on the right side were greater than the left side [6,7,11,15]. Additionally, there are some studies considered that the carrying angle values were greater on dominant side [1,6,19,20]. ...
Article
Full-text available
PurposeThe aim of our study was to determine the carrying angle in human fetuses and to identify variations in carrying angle by gender, fetal age and elbow side in fetal period.Methods This study was carried out on 20 dead human fetuses (13 males, 7 females) fixed with formaldehyde, aged between 10–35 weeks of gestation, without external anomalies. Ages of the fetuses were determined according to the general growth parameters. First, the fetus arms were positioned in 180° extension and the forearms were placed in supination. Then the midpoints of the caput humeri, the elbow joint and the wrist were determined. The photographs were taken from the anterior aspect. The distances between the reference points and carrying angles were measured using ImageJ program in the photographs.ResultsThe mean ± SD values of carrying angle were 14.18 ± 5.52 and 8.21 ± 4.82 degrees in males and in females, respectively. Although there was no difference between right and left sides within both genders, there was a significant difference between genders (p < 0.05). Gestational age and fetal carrying angle showed a medium negative correlation at the right arm and a weak negative correlation at the left arm.Conclusion The existence of a significant difference between fetal carrying angles belong to different genders suggested that the sexual dimorphism of carrying angles may be starting at the early intrauterine period. The carrying angle should be explained with the studies performed in larger series in the prenatal and postnatal periods.
... A study by Balasubramaniam et al. that enrolled rural children from South India did not find a significant correlation between carrying angle and either arm or forearm [5]. However, a study by Kothapalli et al. that enrolled MBBS students reported a negative correlation between carrying angle and length of arm as well as that of the forearm [12]. We found a significant positive correlation between CCA and lengths of the arm and forearm. ...
Article
Purpose: This prospective cohort study aims to determine the correlation between morphometric measurements and the carrying angle of human elbow. Methods: One hundred forty children were enrolled in the study. They were evaluated for age, sex, morphometric measurements, clinical carrying angle (CCA) and radiological carrying angle (RCA). The morphometric measurements included in the study were length of arms and forearms, inter-epicondylar distance of both sides, trans-trochanteric distance, height and body mass index. The mean of carrying angles in unrelated groups (gender and secondary sexual features) was compared using the unpaired t-test. Pearson's correlation coefficient was calculated to determine the strength and direction of the relationship between carrying angle and continuous variables (age, height, body mass index, forearm length, arm length, inter-epicondylar distance and trans-trochanteric distance). Results: The mean age was 5.84±4.76 years. Ninety-eight (70%) were males, and forty-two (30%) were females. The means of RCAs of the left side and right side were 9.07±2.13 and 8.85±2.09, respectively. The mean values of CCA on the left side and right side were 8.77±2.03 and 8.55±2.01 each. A significant positive correlation was found between CCA and age, weight, height, arm length, forearm length, inter-epicondylar distance and trans-trochanteric distance. CCA was found to be significantly negatively correlated with body mass index. Conclusion: CCA is significantly correlated with age, BMI and morphometric measurements.
... In fact, the angle is mainly determined by the Humeroulnar joint. [6][7][8] Developmentally, the radius is ossifi ed with three centers located at: the shaft , and at the two extremities of the radius. Th e proximal ossifi cation center appears around the 5 th year. ...
Article
Full-text available
The radius, also known as the radial bone, is the shorter of the two bones of the human forearm. It has proximal and distal articulations with the humerus, ulna, and carpal bones. It is almost universally present in anytetrapod’s forelimb. The detailed morphometry of radius, has been marginally covered in literature. Specifi cally, the spatial inclination of the head of radius and its articular surfaces. This inclination can be affected in many pathologies including: fractures-dislocations, joint’s degenerations, tumors, and pathologic deposits. This case report aim to present a case of an anomalous inclination of the head of radius, which occurred as a result of a fractured radial shaft below the level of the radial tuberosity. The radial bone, in this case, belonged to a deceased member of the Japanese ethnicity of an unknown age and gender. This report shows the prime value of a normal (physiological) inclination of an articular surface. Understanding the normal inclination, has a tremendous value in biomedical science, biomechanical applications and prosthesis synthesis, corrective surgical and orthopedic procedures, anthropology, forensic sciences,and further application in rheumatology and degenerative joint diseases to be specifi c.
Article
Full-text available
Aim: This study was conducted to determine the difference in carrying angles in the dominant and non-dominant hands of children Study design: Cross-sectional study Methodology: We target 250 normal children with no deformity, ages between 10 to 15 years (either gender). Individuals with a history of fractures and dislocations of and around elbow and shoulder joints and individuals with any congenital anomalies of elbow and shoulder joints were excluded from the study. The carrying angle of both the limbs was measured through Universal Goniometer Results: The carrying angles of the elbows of 250 cases were measured. Among them 125 were females and 125 were males aged between 10-15 years. The carrying angle increases by age on the right side of the hand. After 13 years of age, it increased on the left side. Conclusion: The current study was conducted at the various schools of Hyderabad Pakistan. The carrying angle was higher in females as compared to males. In both genders carrying angle of the dominant hand was more than the non-dominant arm. By increasing age carrying angle also increases till the age of 15 years.
Article
Full-text available
Introduction The elbow joint is a compound joint made of articulations in between the humerus, ulna and the radius. The coupling areas (joints) are of prime importance from the kinetic-biomechanical perspective and of potential inter-ethnic significance. These articulations can be affected by several pathologies that may require medical and surgical interference. This experimental analysis aims to infer data in relation to the morphometry of the proximal segment of the ulna and its articular surfaces represented by the greater sigmoid notch (trochlear notch) and lesser sigmoid notch (radial notch). Methods A sample of fifty ulnae (n=50, 27 right and 23 left) was studied in connection with; the surface area of the sigmoid notches (SA), weight of ulna, and the volume of proximal portion of ulna (including the olecranon process and reaching inferiorly to the lowest margin of the radial notch), the length of ulna (L). Longitudinal dimensional parameters were also studied including; the straight distance between the highest point (tip) of the olecranon and that of the coronoid process (OCD), and the mid-olecranon thickness in mediolateral (T1) and anteroposterior orientation (T2). Results It has been inferred that there were no significant differences in between right versus left ulnae and in relation to the majority of morphometric parameters with an exception for OCD (22.47 vs 20.75, p-value=0.002). There was a positive correlation in between all the parameters, although the strongest associations were observed in between OCD, the area of the trochlear notch, and the weight of ulna. Discussion A precise conclusion was reached in relation to morphometry, volumetry and the pertinent biomechanics of the proximal segment of the ulna. Key findings are of value to biomedical engineers, medical professionals including orthopaedic surgeons and rheumatologists, evolutionary biologist, and physical anthropologist. Data from this study can be used to (reverse) engineer the perfect implant for the elbow joint.
Article
Carrying angle, or cubital angle defined as the acute angle formed by the median axis of the arm when forearm is in fully extended and supinated position. This angle changes with skelatal growth and maturity. This study was aimed to investigate the correlation of carrying angle with bi-acromial diameter and bi-acromial diameter/bi-trochanteric diameter in our healthy young adult population. This was a cross-sectional study that included 400 (204 male, 196 female) young adult students selected from Çukurova University aged between 18-25 years (mean±standard deviation of females: 20.11±2.05 years; mean±standard deviation of males: 20.45±1.82 years) which originated from different cities in Turkey. After recording demographic data, carrying angle, forearm length, arm length, bi-trochanteric diameter and bi-acromial diameter were measured by using nonelastic tape measure, pelvimeter and manuel goniometer. In addition, body mass index and bi-acromial diameter/bi-trochanteric diameter were calculated for each participants. The mean values of body height and weight were in following respectively for both genders: 178.53±6.40 cm (male), 163.88±5.73 cm (female); 74.89±10.81 kg (male), 57.56±8.61 kg (female). Whereas on dominant arm this angle was as in males 9.77°±2.82° and 13.94°±3.97° in females. The mean value of the carrying angle on nondominant arm in males was 9.85°±2.95° and 14.03°±4.08° in females. The mean carrying angle was 9.81°±2.82° in males and 13.99°±3.97° in females. There are linear relationship between the carrying angle and height (r=-0.474, p<0.001, bi-acromial diameter (r=-0.490, p<0.001), bi-acromial diameter/bi-trochanteric diameter (r=-0.449, p<0.001), forearm length (r=-0.366, p<0.001) and arm length (r=-0.273, p<0.001). We believe that the reference values of carrying angle will help the clinician in the management of elbow displacements, fractures, prosthetic design and diagnosis of epicondylar diseases.
Article
Full-text available
Background and Objectives: Prediction of stature from incomplete and decomposing skeletal remains is vital in establishing the identity of an unknown individual. Variety of factors such as race, gender and nutrition play an important role in determining the carrying angle of an individual. There were no study done in Malaysia to find the relationship of the carrying angle with common anthropological parameters and for comparing carrying angle among various ethnic group such as Malay, Chinese and Indians. This study was useful in finding the relationship of the discussed parameters with carrying angle among both genders and comparing between ethnics group in Malaysia. Materials and Methods: A total of 201 participants between ages of 18-25 years were included in the study. The carrying angle was measured and compared among the genders and among ethnic groups and data analysis was done using SPSS version 22. Results and Discussion: The findings indicated significant differences in the carrying angle between the genders and between left and right arm. The variation in carrying angle was significant among the males and females of various ethnicities. Conclusion: The findings in this study will be useful for clinicians, anatomists, archaeologists, anthropologists and forensic scientists when such evidence provides the investigator the only opportunity to gauge that aspect of an individual's physical description which are of value in management of arm fractures, introduction of prosthesis, evolutionary studies and forensic assessments. [Anita Devi K NJIRM 2014; 5(6):20-23] Introduction: The carrying angle of the elbow is defined as the angle formed by the long axis of the arm and the long axis of the forearm in the frontal plane when the elbow is fully extended and the forearm is supinated 1 . In such a position, the forearm does not lie in one line with the arm, but it deviates lateral to the arm axis forming this angle. The evaluation of carrying angle value and its pathologic variations are important to identify the elbow deformities and in the diagnosis of diseases of the lateral and medial epicondyles 2 . Studies have shown that there is a gradual increase in the carrying angle with skeletal maturation 3 .The apparent difference in gender may be due to increased joint laxity in females permitting a greater degree of extension. The average carrying angle is normally greater in females than males as the medial lip of trochlea projects more distally than the lateral lip and the valgus tilt of the distal humeral articulation with respect to the longitudinal axis of humerus is more in females. The carrying angle changes linearly with degree of flexion and extension of the elbow, being greatest
Article
The normal carrying angle in Shiraz population was measured on the basis of sex and age. The right elbow angle of 4266 cases was examined from birth to 30 years old. This study found the carrying angle in 2540 females to be 7.2°(range 2-19) and in 1726 males to be 6.4°(range 2-11), a 0.8°difference. A significant difference (p = 0.05) was found in relation to age. There is a gradual increase in the carrying angle with skeletal maturation.
Article
A radiographic study of the carrying angle in 422 patients demonstrated that the carrying angle increased with age, but there were no real differences in males and females. Apparent differences may be explained by increased joint laxity in females, permitting a greater degree of extension.
Article
Normal Baumann angles in 98 children aged 2 to 13 years and abnormal Baumann angles in 71 children with supracondylar humeral fractures were evaluated. In healthy children, Baumann angles ranged from 64 degrees to 80 degrees (72.4 degrees +/- 4.6 degrees) in boys and from 65 degrees to 81 degrees (72.9 degrees +/- 5.9 degrees) in girls. A significant negative relation (P < 0.01) between Baumann angle and carrying angle was noted, but there were no significant differences in Baumann angles between boys and girls (P > 0.05) and no significant correlation of Baumann angle with increasing age (P > 0.05). In patients with fractures, the Baumann angle measured after immediate reduction correlated well with the carrying angle measured after union or at final follow-up (P < 0.01). This angle measured after reduction may be used to predict the final carrying angle so that cubitus varus deformity can be effectively prevented.
Article
Based on experiments on fresh cadaveric and accidentally amputated 8 upper limbs of children, study of ulnae for presence and absence of non articular strip on the trochlear notch, measurements of carrying angle, length of forearm bones, pronation-supination, height and weight in 2250 infants, children and adults of various age groups and clinical observations on 800 cases of injuries around elbow many new facts have been observed about the development of the carrying angle and its significance in the etiopathogenesis of various types of fractures seen around the elbow. The carrying angle develops in response to pronation of the forearm and is dependent on length of the forearm bones. Lesser the length of forearm bones greater is the carrying angle. So the carrying angle is more in shorter persons as compared to taller persons. It is abduction at the shoulder and not the carrying angle which keeps the swinging upper limbs away from the side of the pelvis during walking. Carrying angle is not a secondary sex character. The type of fracture a child sustains after fall on outstretched hand is also determined by the value of the carrying angle. A new type of fracture hitherto undescribed in the literature, T-Y fracture of the distal humeral epiphysis is also reported.
Article
Repetitive overhead throwing imparts high valgus and extension loads to the athlete's elbow, often leading to either acute or chronic injury or progressive structural change. Tensile force is applied to the medial stabilizing structures with compression on the lateral compartment and shear stress posteriorly. Common injuries encountered in the throwing elbow include ulnar collateral ligament tears, ulnar neuritis, flexor-pronator muscle strain or tendinitis, medial epicondyle apophysitis or avulsion, valgus extension overload syndrome with olecranon osteophytes, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete. Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for the highly motivated athlete. However, continued overhead throwing often results in subsequent injury and symptom recurrence in the competitive athlete.
Article
This article reviews basic concepts in fundamental elbow biomechanics, particularly how they relate to the skeletally immature elbow in throwing athletes. Adult phases of throwing and the forces generated in each phase are compared with the developmental phases of throwing in children. The impact of elevated forces, poor mechanics, and poor coordination are emphasized as they relate to potential areas of injury in the skeletally immature. Finally, concepts in prevention focused on biomechanics are offered.