Carrying angle of the elbow joint in young caucasian and Indian American population: A descriptive cross-sectional study

Chakravarthy Marx Sadacharan; Sukaina B Alikhan; Vasanthakumar Packirisamy; BV Murlimanju

doi:10.4103/JASI.JASI_145_20

ORIGINAL ARTICLE

Year : 2022 | Volume : 71 | Issue : 1 | Page : 42-46

Carrying angle of the elbow joint in young caucasian and Indian American population: A descriptive cross-sectional study

Chakravarthy Marx Sadacharan¹, Sukaina B Alikhan², Vasanthakumar Packirisamy³, BV Murlimanju⁴
¹ School of Biological Sciences (SBS), Morgane 120, 11 Hills Beach Road, University of New England (UNE), Biddeford, Maine, USA
² Medical Student, College of Medicine, American University of Antigua, Antigua, Antigua and Barbuda
³ Basic Sciences, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia, King Abdullah International Medical Research Centre, Al Ahsa, Saudi Arabia
⁴ Department of Anatomy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India

Date of Submission	02-Aug-2020
Date of Acceptance	30-Sep-2021
Date of Web Publication	17-Mar-2022

Correspondence Address:
Dr. Chakravarthy Marx Sadacharan
Associate Professor of Anatomy, School of Biological Sciences (SBS), Morgane 120, 11 Hills Beach Road, University of New England (UNE), Biddeford, Maine
USA

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JASI.JASI_145_20

Abstract

Introduction: To establish normative anthropometric data about the carrying angle, length of the forearm, hip circumference, and body height for young Indian American and Caucasian population and to test statistically the ethnic and gender differences. The objective was also to compare the right and left carrying angle in the ethnic groups. Material and Methods: The present study included 200 students from the American population. Among them, 100 were Caucasians (50 females and 50 males), and 100 were Indian Americans (50 females and 50 males). These participants were aged between 18 and 30 years. Goniometer was used to measure the carrying angle, the hip circumference, body height, and length of forearm were also determined. Results: The present study observed that there was no statistical significance for the carrying angle compared between sides and genders of both the ethnic groups (P > 0.05). The carrying angle was higher (P < 0.05) in Caucasians than in the Indian Americans, both over the right and left upper extremities. This was observed in both the genders. The comparison between genders showed that, carrying angle was higher for females (P < 0.05) than the males in both Caucasians and Indian Americans. Discussion and Conclusion: This investigation contributes the morphological database in Indian Americans and Caucasians for the carrying angle. The morphological findings of this study could be used as reference values for the clinical application and ergonomics. The knowledge about the carrying angle is imperative during the surgical procedures at the elbow joint.

Keywords: Asian Indian Americans, Caucasian race, elbow joint

How to cite this article:
Sadacharan CM, Alikhan SB, Packirisamy V, Murlimanju B V. Carrying angle of the elbow joint in young caucasian and Indian American population: A descriptive cross-sectional study. J Anat Soc India 2022;71:42-6

How to cite this URL:
Sadacharan CM, Alikhan SB, Packirisamy V, Murlimanju B V. Carrying angle of the elbow joint in young caucasian and Indian American population: A descriptive cross-sectional study. J Anat Soc India [serial online] 2022 [cited 2022 May 24];71:42-6. Available from: https://www.jasi.org.in/text.asp?2022/71/1/42/339872

Introduction

In the normal anatomical position, the long axes of brachium and ante brachium form an acute angle medially; this angle at the elbow joint is known as the carrying angle.^[1] The trochlear groove of humerus is vertically oriented anteriorly, and there is oblique orientation posteriorly. This provides the carrying angle.^[2] The carrying angle provides the range of mobility at the elbow joint and allows the forearm to move away from the hip during the swing phase of walking. The movement of forearms away from the hip joint is also important while carrying the objects. However, a higher carrying angle will contribute to the formation of conditions such as elbow pain, instability, and valgus deformity. This may also cause difficulty in throwing the objects like in the sports. Increased carrying angle will reduce the elbow flexion, can cause dislocation and fracture when one falls on an outstretched hand. The best example is the fracture of distal humeral epiphysis.^[3],[4],[5] The normal data of the carrying angle is essential during the anthropological evaluation during the sex determination of skeletal remains in medicolegal circumstances. It will also help in lessening the complications following the supracondylar fractures of the humerus, including the cosmetic deformities. Information about the carrying angle may also help in designing the total elbow prosthesis following the elbow injury.^[6],[7]

In the literature, there are few studies available which compared the carrying angle with respect to the sides and genders. The comparison was also done between the dominant and nondominant extremities. However, there are only few reports which focus on the ancestor-based variations in the carrying angle. The data are not available about the carrying angle in younger population of Caucasians and Indian Americans.

Aims and objectives

The aim of this present study was to obtain the normal anthropometric data about the carrying angle, length of the forearm, hip circumference, and height of the person from Indian American and Caucasians young population and compare them statistically. The objective was also to compare the right and left carrying angle in the ethnic groups.

Material and Methods

The present study included 200 students from the American population [Figure 1]. Among them, 100 were Caucasians [50 from each gender, [Figure 1]a and [Figure 1]b], and 100 were Indian Americans [50 from each gender, [Figure 1]c and [Figure 1]d]. These are from younger population, who were aged between 18 and 30 years. The individuals with the previous history of upper extremity fractures, congenital bony deformities, and nutritional skeletal disorders were not included in this study. The goniometer was used to measure the carrying angle. The measurement was performed as per the Ruparelia et al.,^[7] however, there was slight modification. The other parameters such as hip circumference, length of forearm, height, and age were also determined. The present study was approved by the Ethics Committee of American University of Antigua, College of Medicine.

Figure 1: Schematic representation of the carrying angle in Caucasian male (a), Caucasian female (b), Indian American female (c) and Indian American male (d)

Click here to view

Measurement of carrying angle

The participants of this study were requested to stand in the anatomical position. The arm of the goniometer was placed in a straight line, and its measurement plate was placed at the fulcrum of the elbow joint. The arm of the goniometer was aligned with the central part of the participant's upper arm. The other arm of the goniometer was swung until it was aligned with the center of the participant's forearm. The measurement plate of the goniometer gave the reading of carrying angle, and the same procedure was repeated for the other elbow joint.^[8]

Measurement of height, forearm length, and hip circumference

Height

The height was measured using stature meter from vertex to heel with barefoot.^[8]

Forearm length

The length of forearm was measured by using the digital Vernier caliper of 16”. The distance between the medial epicondyle of humerus and styloid process of ulna was considered as the length of forearm.

Hip circumference

The width of the hip (waist) was determined with a simple measuring meter.

Measurements

All the measurements were performed by two same persons. The values were given as centimeters, and the carrying angle was read in degrees. Special care and comfort were offered to the participants while performing these measurements. Three readings were taken for each measurement by the same observer. The third reading was taken when the first two readings exhibited a larger discrepancy. The two closer readings were considered to minimize the errors, and the mean reading was calculated.

Analysis of the data

Graph Pad Prism software (version 3.00, San Diego, California, USA) was used to perform the statistical analysis. The mean and standard deviation were calculated for each of the measurements in both the genders of both ethnic groups. The values were compared statistically using the two-way factorial analysis of variance. The statistical significance was considered at 5% (P < 0.05), with two-tailed values. The independent t-test was applied by categorizing the participants into groups. Pearson correlation analysis was performed among the age and other anthropometric parameters.

Results

Comparison of carrying angle over the right and left sides

The present study observed that there was no statistical significance [Table 1] for the carrying angle compared over the left and right sides (P > 0.05). There was no statistically significant difference observed (P > 0.05) in both genders of both ethnic groups.

Table 1: Comparison of the carrying angle over right and left sides

Click here to view

Comparison of the data among male Caucasian and Indian Americans

The present study observed that the Caucasians were taller (P < 0.05) than the Indian Americans with respect to male population [Table 2]. The difference was not significant statistically with respect to the hip circumference (P > 0.05). The forearm length was higher in Caucasians than the Indian Americans (P < 0.05) in both the sides. The carrying angle was higher (P < 0.05) in Caucasian males than the Indian American males both over the right and left sides.

Table 2: Comparison of the data among male Caucasian (n=50) and Indian (n=50) Americans

Click here to view

Comparison of the data among female Caucasian and Indian Americans

The present study observed that the Caucasians were taller (P < 0.05) than the Indian Americans [Table 3] with respect to female groups. The difference was not significant statistically with respect to the hip circumference (P > 0.05). The forearm length was not different statistically (P > 0.05) when compared between these ethnic groups over both the sides. However, the carrying angle was higher (P < 0.05) in Caucasian females than the Indian American females on both the sides.

Table 3: Comparison of the data among female Caucasians (n=50) and Indian Americans (n=50)

Click here to view

Comparison of the data among female and male Caucasians

The present study observed that the males were taller than the females (P < 0.05) in Caucasians [Table 4]. The significant difference was not observed statistically between the females and males (P > 0.05) in relation to the hip circumference. The forearm length was higher for males (P < 0.05) than in females in Caucasians. The carrying angle was more (P < 0.05) in female Caucasians than the male Caucasians over both the sides.

Table 4: Comparison of the data among female (n=50) and male (n=50) Caucasian Americans

Click here to view

Comparison of the data among female and male Indian Americans

The present study observed that the males were taller than the females (P < 0.05) in the Indian American Population [Table 5]. The comparison between male and female did not reveal statistical significance (P > 0.05) in relation to the hip circumference. The forearm length was also not significant statistically when compared between the genders (P > 0.05) in the Indian American population. The reading of carrying angle was more (P < 0.05) in female Indian Americans than the male Indian Americans over the left and right sides.

Table 5: Comparison of the data among female (n=50) and male (n=50) Indian Americans

Click here to view

The present study carrying angle data were compared with the previous reports of other populations and are represented in [Table 6].

Table 6: Global comparison of the carrying angle in other ethnic younger population

Click here to view

Discussion

The wider pelvis and small shoulders, offer higher carrying angle in females than the males.^[14],[15] However, some studies report that there is no difference in the carrying angles of males and females.^[9],[15] Few studies reported that, carrying angle will be higher in the dominant upper limb than the nondominant.^{[14],[16],[17]} In this study, the statistically significant difference was not observed (P > 0.05) between the side-based and gender-based comparison in both ethnic groups. The muscle bulk may be more for the dominant upper limb, and there may be slighter greater carrying angle over the right side, but this was not statistically significant (P > 0.05). This research observed the highest carrying angle in females (P < 0.05) than in the males, in both the population. Khare et al.^[18] opined that carrying angle is not correlated with the width of pelvis, and it is not a secondary sexual character. However, there is overlapping of the carrying angle in males and females.^[15],[19] Carrying angle differs from individual to individual; hence, it is important to compare both the elbow joints during the evaluation. The present study compared the carrying angle with different ethnic groups globally [Table 6], and there were lots of variations. This may be due to ancestral and geographic variations. Carrying angle may help in the sex determination and is of interest to the anthropologists. The anthropometry varies between genders, ancestry, food intake, geography, and the environment.^[20] It was reported that the data of certain population cannot be applied to other population^[21] and this requires data for a particular region. The United States is a country, which has many ethnic groups who migrated there for the occupation. The morphometric data of these ethnic groups are not recorded separately. Indians in America are the second-largest migratory group in the United States. The data available for the American population have been taken from the Caucasians and therefore these data cannot be used for the Indian Americans.

The anthropometric data of various ethnic and ancestral groups need to be determined for establishing the normal database.^[22] The elbow surgeries performed on the Indian American patient require the data from Indian American population only. The instruments and prosthesis cannot be taken from the Caucasian size. Hence, it is suggested to obtain data from different ethnic groups to determine the reference values for that particular population. There are few studies available from Indian populations within India for the carrying angle.^[7],[14] However, there are no reports available about the carrying angle of the elbow with other parameters in Indian American population. Indian Americans are the Indians who migrated to the United States. Most of the Indian Americans in this present study were born in the United States, but their parents or grandparents have migrated to the United States from India. The American data are not accurate to be used for this Indian American population. Even the Indian data cannot be considered because these individuals have lived in the United States for the longer time. There will be environmental, geographical, genetic, ancestral, and nutritional variations. The height, hip circumference, forearm length, and carrying angle were higher for the Caucasians (P > 0.05) than the Indian Americans. This is because the Caucasians are tall and robust in comparison to the Indians. The age of the Caucasian students was slightly higher than the Indian American students, because Caucasians join the school, slightly later in their age. Indian students join the schools according to their age. The data of Indian American are essential to treat the patients of this ethnic group during the conditions like elbow surgeries. The data regarding the carrying angle with other parameters may help the operating surgeon during the orthopedic procedures like correction of cubitus varus deformity.

The present study has few limitations like few of the participants of this study have lived in different continents. For example, they have lived both in India and the United States. The data will be more accurate if the participants belong to the same geographical location from their ancestors of three, four generations. The sample size of one hundred in each population group studied may be lesser for this study. The data will be more accurate with a larger sample size. The present study did not correlate the carrying angle radiologically. The carrying angle can be calculated radiologically using the software like “Radiant,” after obtaining the X-ray films.

Conclusion

The present study has provided the data about the carrying angle and other parameters such as forearm length, hip circumference in Indian Americans and Caucasians. These data can be used as reference data for these population subgroups. The data of the present study have implications in the shoulder and elbow surgery. The data are also enlightening to the anthropologists and morphologists.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, et al. Gray's Anatomy. 38^th ed. London: Churchill Livingstone; 1995. p. 642-3.
2.	Kapandji IA. The physiology of the joints, Vol 1, upper limb. New York: Churchill. Livingstone; 1982. p. 72-97.
3.	Cain EL Jr., Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: A current concepts review. Am J Sports Med 2003;31:621-35.
4.	Hutchinson MR, Wynn S. Biomechanics and development of the elbow in the young throwing athlete. Clin Sports Med 2004;23:531-44.
5.	Van Roy P, Baeyens JP, Fauvart D, Lanssiers R, Clarijs JP. Arthro-kinematics of the elbow: Study of the carrying angle. Ergonomics 2005;48:1645-56.
6.	Punia RS, Sharma R, Usmani JA. The carrying angle in an Indian population. J Anat Soc India 1994;43:107-10.
7.	Ruparelia S, Patel S, Zalawadia A, Shah S, Patel SV. Study of carrying angle and its correlation with various parameters. Nat J Int Res Med 2010;1:28-32.
8.	Rajesh B, Reshma VR, Jaene RC, Somasekhar IT, Vaithilingam A. An evaluation of the carrying angle of the elbow joint in adolescents. Int J Med Biomed Res 2013;2:221-5.
9.	Sharma K, Mansur DI, Khanal K, Haque MK. Variation of carrying angle with age, sex, height and special reference to side. Kathmandu Univ Med J (KUMJ) 2013;11:315-8.
10.	Chinweife KC, Ejimofor OC, Ezejindu DN. Correlation of carrying angle of the elbow in full extension and hip-circumference in adolescents of Nnewi people in Anambra state. Int J Sci Res Pub 2014;4:1-8.
11.	Açıkgöz AK, Balci RS, Göker P, Bozkir MG. Evaluation of the elbow carrying angle in healthy individuals. Int J Morphol 2018;36:135-9.
12.	Allouh MZ, Abu Ghaida JH, Jarrar AA, Khasawneh RR, Mustafa AG, Bashaireh KM. The carrying angle: Racial differences and relevance to inter-epicondylar distance of the humerus. Folia Morphol (Warsz) 2016;75:388-92.
13.	Kothapalli J, Murudkar PH, Seerla LD. The carrying angle of elbow – A correlative and comparative study. Int J Curr Res Rev 2013;5:71.
14.	Tükenmez M, Demirel H, Perçin S, Tezeren G. Measurement of the carrying angle of the elbow in 2,000 children at ages six and fourteen years. Acta Orthop Traumatol Turc 2004;38:274-6.
15.	Steel FL, Tomlinson JD. The carrying angle in man. J Anat 1958;92:315-7.
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;26:19-23.
17.	Yilmaz E, Karakurt L, Belhan O, Bulut M, Serin E, Avci M. Variation of carrying angle with age, sex, and special reference to side. Orthopedics 2005;28:1360-3.
18.	Khare GN, Goel SC, Saraf SK, Singh G, Mohanty C. New observations on carrying angle. Indian J Med Sci 1999;53:61-7. [PUBMED] [Full text]
19.	Zampagni ML, Casino D, Zaffagnini S, Visani AA, Marcacci M. Estimating the elbow carrying angle with an electrogoniometer: Acquisition of data and reliability of measurements. Orthopedics 2008;31:370.
20.	Wankhede KP, Kamdi NY, Parchand MP, Anjankar VP, Bardale RV. Estimation of stature from maxillo-facial anthropometry in a central Indian population. J Forensic Dent Sci 2012;4:34-7. [PUBMED] [Full text]
21.	Siddiqui MA, Shah MA. Estimation of stature from long bones of Punjabis. Indian J Med Res 1944;32:105-8.
22.	Kunjur J, Sabesan T, Ilankovan V. Anthropometric analysis of eyebrows and eyelids: An inter-racial study. Br J Oral Maxillofac Surg 2006;44:89-93.