#anteversion

Uterus position pt. 2: finding the ‘version’ (tilt)

If you can reach your cervix yourself, you will most likely be able to tell the version or tilt of your cervix. You can also ask your doctor or another health professional to check for you.

Anteversion. If your cervix is anteverted, it will be angled towards the bladder and the opening of the cervix will point towards the rectum.

Midposition. If your cervix is midposed, the opening will be pointing straight downwards.

Retroversion. If your cervix is retroverted, it will be angled towards the rectum and the opening of the cervix will point towards the bladder.

This young lad presents to your office complaining of bilateral knee discomfort at the medial aspect, just below the patella, particularly when ascending and descending stairs and hills. You narrow it down to abnormal patellar tracking and 2 possibilities of who is driving the bus, but which is it? Torsions of an extremity are said to exist when they measure two or more standard deviation‘s outside of normal. In external tibial torsion, the shaft of the tibia over rotates more than it’s 1.5° per year from zero at birth to greater than 19°. You are left with a foot that is has an increased progression angle and a center of gravity falls medial to the foot causing abnormal patellar tracking. Femoral retro torsion is said to exist when the head of the femur over reduces from its 35° angle at birth to less than 8° resulting in severely limited internal rotation of the hips bilaterally. The lower extremity is often externally rotated to compensate. An easy differential for the 2 is to drop a plumbline from the tibial tuberosity through the foot. This line normally passes through the second or between the second and third metatarsal‘s. If it falls medial to that it is eternal tibial torsion and lateral to that most likely internal tibial torsion or potentially a metatarsus varus or forefoot adductus.

Another differential would be to perform “Craigs test” and measure how much internal and external rotation of the femur there is at the femoral acetabular articulation. An easier way to put it is; those with femoral retrotorsion have less hip internal rotation and often increased amounts of external rotation; often they can’t even get past zero, never mind the requisite 4-6 degrees for normal gait. Those with increased internal rotation and diminished external rotation most likely have femoral antetorsion.

Most common:

Anteverted + anteflexed (forward facing and forward bend)

Retroverted + retroflexed (backward facing and backward bend)

Midposed with slight anteflexion or retroflexion (pointing upwards with a slight bend either forward or backward)

Least common:

Severe anteflexion or retroflexion

Anteverted + retroflexed (forward facing and backward bend)

Retroverted + anteflexed (backward facing and forward bend)

 Here is a free, full text article that talks about using 3D CT for a precise measurement of things like femoral and tibial torsions and versions. Remember that this will directly influence the amount of internal and external rotation of the hip, which will have a direct influence on gait. Remember you need 4-6 degrees of internal and external rotation to ambulate normally

Dr Ivo Waerlop, one of The Gait Guys

Byun HY, Shin H, Lee ES, Kong MS, Lee SH, Lee CH. The Availability of Radiological Measurement of Femoral Anteversion Angle: Three-Dimensional Computed Tomography Reconstruction. Ann Rehabil Med. 2016;40(2):237-43.

#gait, #measurement, #femoraltorsion, #femoralversion, #antetorsion, #anteversion, #retrotorsion, #retroversion