Indian Journal of Orthopaedics Surgery 2023;9(4):237–242

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Indian Journal of Orthopaedics Surgery

Journal homepage: https://www.ijos.co.in/

Original Research Article

Variation in carrying angle - A normative study

Mohammed Shadab Khan 1 *, Rakesh B Singh 1

1 Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India

ARTICLE INFO ABSTRACT

Article history: Background: The synovial joint that comprises the elbow is a hinge joint with a single degree of freedom,
Received 30-07-2023 allowing for flexion and extension movements. The primary objective of this study was to investigate the
Accepted 23-10-2023 varying carrying angles that were observed.
Available online 07-12-2023 Materials and Methods: An observational study was conducted in the Department of Orthopaedics
Heritage Institute of medical sciences Varanasi. Around 500 samples were taken for a period of 2 years. All
patients of both genders inclusive of age group 8 to 19 years were taken with their consent. Asymptomatic
Keywords: individuals without any deformity, fractures, anomalies and previous history of surgery around elbow were
Carrying angle included. All with previous elbow injuries and anomalies around elbow, history of Endocrine disorders,
Elbow
athletes and deformity occurring after any elbow injury were excluded.
Injury
Results: The present study was conducted in the Department of Orthopaedics, Heritage Institute of
Hinge joint Medical Sciences, Varanasi with the objective to observe the physiological factors responsible for the
change in the carrying angle in normal individuals in a tabulated manner. A total of 500 patients were
included in the study. There was no significant (p>0.05) difference in carrying angle between male and
females among different age groups. There was no significant (p>0.05) difference in carrying angle between
male and females among different height groups. Only age was positively significantly (r=0.48, p=0.001)
correlated with carrying angle.
Conclusion: Females had a considerably higher carrying angle (12.96±2.44) than males (12.19±1.74)
(p=0.001). There was no significant difference in carrying angle across height groups or genders (p>0.05).
Age correlated positively with carrying angle (r=0.48, p=0.001).

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1. Introduction the forearm is supinated, the elbow is fully extended, and

the shoulder is rotated outward.
The synovial joint that comprises the elbow is a hinge
joint with a single degree of freedom, allowing for flexion The carrying angle is influenced by the projection of
and extension movements (Fornalski et al., 2003). 1 It is the medial trochlear ridge and the obliquity of the superior
formed by the articulation of the upper ends of the radius articular surface of the coronoid (Lim et al., 2014). 3 When
and ulna with the lower end of the humerus. The angle the ulnar and humeral articular surfaces are aligned in the
formed between the arm’s median axis and the completely same plane during maximum flexion, the carrying angle is
extended and supinated forearm, known as the carrying eliminated, which occurs when the shoulder joint is fully
angle, describes the forearm’s lateral obliquity (Acikgoz et extended.
al., 2018). 2 This angle is most accurately measured when In the typical working position of the forearm,
* Corresponding author. almost complete supination results in a more straightened
E-mail address: drshadabk92@gmail.com (M. S. Khan). alignment between the upper arm and the forearm. The

https://doi.org/10.18231/j.ijos.2023.045
2395-1354/© 2023 Author(s), Published by Innovative Publication. 237
238 Khan and Singh / Indian Journal of Orthopaedics Surgery 2023;9(4):237–242

carrying angle is crucial for tasks involving carrying alignment is gradually acquired during childhood.
objects as it allows the arms to clear the hips during The primary objective of this study was to investigate the
swinging movements while walking (Robert McMinn, varying carrying angles that were observed.
2019). 4 The carrying angle varies between individuals
and is generally greater in females compared to males,
2. Materials and Methods
possibly due to differences in body proportions and the
occurrence of pregnancy (Maria Luisa Zampagni et al., An observational study was conducted in the Department
2008; Balasubramanian et al., 2006). 5,6 It is also considered of Orthopaedics Heritage Institute of medical sciences
a secondary sexual characteristic. Additionally, the carrying Varanasi. Around 500 samples were taken for a period of
angle tends to be lower in the non-dominant extremity 2 years. All patients of both genders inclusive of age group
compared to the dominant extremity in both genders. 8 to 19 years were taken with their consent. Asymptomatic
The normal carrying angle ranges from 5◦ to 10◦ individuals without any deformity, fractures, anomalies and
for males and 10◦ to 15◦ for females. Values above previous history of surgery around elbow. All with previous
15 degrees are referred to as cubitus valgus, while elbow injuries and anomalies around elbow, history of
values below 5 degrees are termed cubitus varus. The Endocrine disorders, athletes and deformity occurring after
carrying angle’s pathophysiology can be influenced by any elbow injury were excluded.
factors such as elbow joint overextension, gender, age, “Carrying angle: The carrying angle of the elbow of
and anthropometric parameters like the distance between both handsmeasured using a full circle goniometer made of
the trochanters and height. It can also be affected by flexible clear plastic. All the bony landmarks were palpated
traumatic injuries, fractures, ligamentous laxity, congenital and marked. The measurement was taken by placing the
deformities, rheumatic or inflammatory diseases, and goniometer’s measurement plate at the fulcrum (biceps
hereditary conditions (Terra et al., 2011). 7 Significant brachii tendon) of elbow. The fixed arm is placed on the
differences in carrying angles between the left and right median axis of the upper arm, the movable arm adjusted on
sides can also occur. the median axis of forearm. The arrow on the goniometer
The carrying angle’s variation has implications for the measurement plate indicates the angle (Balasubramanian et
muscular strength of the upper extremities, particularly al, 2006). 7
the hands (Hogrel, 2015). 8 As individuals grow and their Measurement of height of the sample was taken using
skeletons develop, the carrying angle adjusts accordingly. an inch tape. Height was measured from vertex to heel
It is particularly important for maintaining proper forearm of the individual with bare foot in anatomical position in
clearance during activities involving object carrying. centimeters. The length of the arm is measured from the
Research aims to establish baseline carrying angle values for angle of acromion to the lateral epicondyle of humerus.
different age groups and understand how the angle evolves The forearm length is measured from the lateral
with skeletal growth (Tomori et al., 2018). 8 epicondyle of the humerus to the tip of the radial styloid
Increased carrying angle can lead to elbow pain, process (Chakravarty and Bordaloi, 2020). Axis of arm
instability during throwing activities or exercise, and is defined by the midpoints of two lines perpendicular to
reduced elbow flexion function, increasing the risk of the shaft spaced as far apart as possible Axis of forearm
dislocation or fractures (Langenskiold and Kivilaakso, is defined by the midpoints of two lines perpendicular to
1967). 9 Grip strength, an integral performance requiring the forearm bones (lateral border of the radius and medial
multiple muscles, is closely related to the carrying angle border of the ulna).
and is used to assess upper limb damage and determine
appropriate treatments (Sharma et al., 2013). 10 Hand grip 3. Results
strength relies on the coordinated functioning of the muscles
in the forearm, prescapular region, and shoulder. Changes in The present study was conducted in the Department
the carrying angle can impact grip strength (Rashed et al., of Orthopaedics, Heritage Institute of Medical Sciences,
2019). 11 Varanasi with the objective to observe the physiological
Visual assessment and hinged goniometers are factors responsible for the change in the carrying angle in
commonly used by clinicians to evaluate angulation. normal individuals in a tabulated manner. A total of 500
Clinical pictures are helpful in tracking deformity patients were included in the study.
progression or improvement over time. Normal variations About one third of patients were between 17-19 years of
in alignment include a carrying angle of approximately age (31.6%) followed by 8-10 (31.2%), 11-13 (25.6%) and
15 degrees of varus when the elbow is fully extended, 14-16 (11.6%). About half of patients were males (51.8%).
ranging from nearly zero degrees of valgus to at least 20 Height between 131-150 cms was among more than one
degrees (Herring, 2021).13 Varus deformity can result from third of patients (42.6%) followed by 110-130 cms (38.6%),
improperly fused elbow fractures, while normal valgus 151-170 cms (17.6%) and >170 cms (1.2%) (Table 1).
 Khan and Singh / Indian Journal of Orthopaedics Surgery 2023;9(4):237–242 239

Table 1: Distribution of variables among the study participants higher among females (12.96±2.44) compared to males
(N=500) (12.19±1.74).
S. No. Variable Frequency Percentage
1 Age
8-10 156 31.2
11-13 128 25.6
14-16 58 11.6
17-19 158 31.6
2 Gender
Male 259 51.8
Female 241 48.2
3 Height in Cms
110-130 193 38.6
131-150 213 42.6
151-170 88 17.6
>170 6 1.2

Figure 3: Comparison of carrying angle with Height

Figure 3 shows the comparison carrying angle with

height. There was no significant (p>0.05) difference in
carrying angle among different height groups.

Table 2: Comparison of carrying angle with age and gender

Carrying angle (Mean±SD
Age in years p-value 1
Male Female
8-10 11.43±1.67 11.16±1.58 0.30
11-13 11.93±2.01 12.57±2.62 0.22
14-16 12.11±1.48 13.78±2.91 0.34
Figure 1: Comparison of carrying angle with age 17-19 13.23±1.08 14.68±1.26 0.19
1 Unpaired t-test

Figure 1 shows the comparison carrying angle with age.

The carrying angle was higher among age 17-19 years Table 2 shows the comparison carrying angle with age
(13.96±1.37) than 14-16 (12.83±2.34), 11-13 (12.23±2.33) and gender. There was no significant (p>0.05) difference in
and 8-10 (11.30±1.63) years. However, difference was carrying angle between male and females among different
statistically insignificant (p>0.05). age groups.

Table 3: Comparison of carrying angle with height and gender

Height in Carrying angle (Mean±SD
p-value 1
cms Male Female
110-130 12.09±1.72 12.78±2.42 0.34
131-150 12.28±1.86 13.01±2.54 0.11
151-170 12.25±1.58 13.43±2.02 0.09
>170 11.60±2.07 10.00±1.42 0.13
1 Unpaired t-test

Table 3 shows the comparison carrying angle with height

and gender. There was no significant (p>0.05) difference in
carrying angle between male and females among different
Figure 2: Comparison of carrying angle with gender height groups.
Table 4 shows the correlation of carrying angle with age
Figure 2 shows the comparison carrying angle with and height. Only age was positively significantly (r=0.48,
gender. The carrying angle was significantly (p=0.001) p=0.001) correlated with carrying angle.
240 Khan and Singh / Indian Journal of Orthopaedics Surgery 2023;9(4):237–242

Table 4: Correlation of carrying angle with age and height A study that was done on healthy Chinese children and
Carrying angle published in Dai, 1999 17 found that there is a negative
Correlation p-value 1 association between Baumann’s angle and carrying angle.
coefficient When treating displaced supracondylar fracture, however,
Age in years 0.48 0.001* it was discovered that Baumann’s angle was an incorrect
Height in cms 0.07 0.50 indication of the carrying angle (Mohammad et al, 1999). 18
1 Pearson correlation There has not been a lot of research done on the effect that
body features have on the carrying angle at the elbow in the
paediatric population.
4. Discussion The present study was carried out in the Department of
Orthopaedics at the Heritage Institute of Medical Sciences
When the elbow joint is fully extended and in the supinated
in Varanasi with the intention of observing and tabulating
position, the forearm is not in a straight line with the
the physiological parameters responsible for the change in
arm; rather, it is laterally deflected, and an angle is formed
the carrying angle in normal individuals. The study had a
between the long axis of the arm and the long axis of the
total of five hundred different participants.
forearm. This occurs when the elbow joint is in the fully
extended and supinated position. The carrying angle of the The patients in this study ranged in age from 8-10 years
elbow refers to this particular angle of the elbow (Snell, old (31.2 percent), 11-13 years old (25.6 percent), and 14-
2004). 12 16 years old. The oldest patient in this study was 17-19
years old (31.6 percent) (11.6 percent). Roughly half of the
It would appear that the carrying angle is developed as a
patients were identified as male (51.8 percent). According
reaction to the pronation of the forearm, and its function is
to the findings of Bhatti et al (2022), 19 out of a total of 500
to keep the swinging upper extremity away from the side of
cases, there were 125 females and 125 males between the
the pelvis while walking (Khare et al, 1999). 13
ages of 10 and 15. The research conducted by Sadacharan
The most distal location of the trochlea in comparison to et al. (2022) 20 includes the participation of two hundred
the capitulum in the humerus and a minor valgus angulation students from the American population. 100 of them were
of the trochlear notch of the ulna in relation to the shaft white (50 females and 50 males), and the other 100 were
of the humerus are the anatomical explanations for this Native Americans (100 males and 100 females) (50 females
phenomenon (Maria Luisa Zampagni et al, 2008. 5 and 50 males). All of these volunteers ranged in age from
The carrying angle and the range of motion at the elbow 18 to 30 years old. Kushwaha et al. (2022) 21 found that the
joint both increase with age up to the time that skeletal average age was 5.84 years with a standard deviation of 4.76
maturity is reached in children who are healthy (Golden et years. There were 98 males, making up 70% of the total, and
al, 2007). 14 there were 42 girls, making up 30% of the total.
The clinical carrying angle (CCA), on the other hand, is In the present study, Height between 131-150 cms was
shown to increase up to the age of 15 years, after which among more than one third of patients (42.6%) followed by
it shows a modest decrease in angle. This was shown in 110-130 cms (38.6%), 151-170 cms (17.6%) and >170 cms
a study. According to the findings of the same study, the (1.2%).
increase rate each year for boys was found to be 0.42, while The current study showed that the carrying angle was
the rate for girls was found to be 0.60. The average carrying higher among age 17-19 years (13.96±1.37) than 14-16
angle for males and females in adults is 10 degrees, and it is (12.83±2.34), 11-13 (12.23±2.33) and 8-10 (11.30±1.63)
13 degrees, respectively (Balasubramanian et al, 2006). 6 years. However, difference was statistically insignificant
An increase in the carrying angle during the growing (p>0.05). Bhatti et al (2022) 19 showed that the carrying
years might raise the risk of elbow instability, pain angle increases by age on the right side of the hand. After
during exercise and throwing, decreased flexion at the 13 years of age, it increased on the left side. By increasing
elbow, increased likelihood of dislocation of the elbow, age carrying angle also increased till the age of 15 years.
and increased likelihood of fracture of the distal humeral According to the findings of this research, the carrying
epiphysis (Robinson et al, 2017). 15 angle was substantially (p = 0.001) greater among females
In addition to this, it has been noted that a carrying angle (12.96±2.44) than it was among males (12.19±1.74). In line
of more than 15 degrees is a risk factor for non-traumatic with the findings of this investigation, Bhatti et al. (2022) 19
injuries. Several studies have been conducted to investigate discovered that the carrying angle was much greater in
the relationship between carrying angle and factors such as females than in males. It was found by Sadacharan et al
age, sex, dominant side, and body characteristics such as (2022) 20 that there was no statistical significance when
trans-trochanteric diameter, height, length of the forearm, comparing the carrying angle between the sexes and sides
length of the arm constitution, race, and inter-epicondylar of both ethnic groups (P > 0.05). Both over the right and
distance (Allouh et al, 2016). 16 left upper extremities, the carrying angle was greater (P
 Khan and Singh / Indian Journal of Orthopaedics Surgery 2023;9(4):237–242 241

<0.05) in Caucasians than in Indian Americans. This was the The CCA was found to be linked with a number of other
case regardless of race. This was noticed in both males and variables, including age, secondary sexual features, weight,
females of the population. The analysis that compared the height, arm length, forearm length, inter-epicondylar
carrying angles of males and females found that the carrying distance, trans-trochanteric distance, and Baumann’s angle,
angle of females was greater (P <0.05) than that of males according to the results of a bivariable analysis. It was
in both the Caucasian and Indian American populations. In discovered that there was a substantial inverse correlation
the research carried out by Gupta et al. (2022), 22 the mean between CCA and BMI. When comparing carrying angle
carrying angle was found to be 8.9 degrees on the right side with height and forearm length, Shah and Naqvi (2020) 27
and 8.5 degrees on the left side in females. In contrast, the discovered that the p-value was less than 0.05, which
mean carrying angle was found to be 7.1 degrees on the right indicated that there was a significant correlation between
side and 6.4 degrees on the left side in males. The angle was the three variables. Therefore, there existed an inverse
more on the side that was dominant than it was on the side relationship between the height of the individual and the
that was not dominant. The carrying angle was shown to be carrying angle. Due to the fact that the height and forearm
greater in females than in males, according to Nemuri et al length are directly related to one another, it follows that
(2020). 23 Therefore, the median carrying angle for females the forearm length is also related to the carrying angle.
was 16 degrees on the right side and 9 degrees on the left. When comparing carrying angle to age, the p-value was
The typical carrying angle for males was 10 degrees on determined to be more than 0.05, indicating that the
the right side and 6 degrees on the left. The mean carrying correlation was not significant. As a result, there was not
angle for males was found to be 10.33± 1.56 degrees in the a significant difference in carrying with age because the
right limb and 12.11 ±1.72 degrees in the left limb in the patients were all within the same age range. The conclusion
research conducted by Chakravarty and Bordaloi (2020). 24 of the study was that the carrying angle was dependent
For females, the mean carrying angle was found to be 11.73 on the length of the bone in the forearm. If the bone
±2.73 degrees on the right side and 11.45 ±3.26 degrees on length was much longer, then the angulation of the proximal
the left side. It was discovered by Beigh et al. (2019) 25 that articulation of the proximal articular surface would be
the carrying angle differs between males and females, with lower; as a result, the carrying angle would be lower; and
females having values that are higher in both their dominant vice versa.
and non-dominant limbs in comparison to males. 19 According to the findings of Nemuri et al. (2020), 23
The carrying angle in the Indian population was there was a statistically significant variation in the carrying
investigated by Walankar and Verma (2018). 26 In a standing angle between boys and females of the same age group.
anatomical position, carrying angle was measured with Carrying angle on the dominant side was greater than on
a half circle universal goniometer in 600 healthy people the non-dominant side. In females, the researchers found no
ranging in age from 21 to 80 years. Males had a mean evidence of a significant correlation between the carrying
carrying angle of 10.18 degrees and 9.160 degrees, while angle and the hip circumference. In females, the researchers
females had a mean carrying angle of 14.20 degrees and found no evidence of a significant correlation between the
13.090 degrees in their dominant and non-dominant arms, angle of carrying and their weight.
respectively. It was observed that females had a greater
carrying angle than men. Additionally, the dominant arm 5. Conclusion
had a larger carrying angle than the non-dominant arm. 12
About one third of patients were between 17-19 years of
In this particular investigation, a comparison of age (31.6%), followed by 8-10 (31.2%), 11-13 (25.6%),
carrying angle between different height groups revealed and 14-16 (11.6%). Approximately half of the patients
no statistically significant differences (p>0.05). According were males (51.8%). In terms of height, more than
to the findings of this study, the amount of difference in one third of patients fell within the range of 131-150
carrying angle between boys and girls of varying ages did cm (42.6%), followed by 110-130 cm (38.6%), 151-
not meet the criteria for statistical significance (p>0.05). 170 cm (17.6%), and >170 cm (1.2%). The carrying
According to the findings of this particular study, there angle was higher among individuals aged 17-19 years
was not a significant difference (p>0.05) in the carrying (13.96±1.37) compared to those aged 14-16 (12.83±2.34),
angle between males and females across a variety of height 11-13 (12.23±2.33), and 8-10 (11.30±1.63) years, but
categories. In this particular research, the only variable that the difference was not statistically significant (p>0.05).
showed a significant positive correlation with carrying angle However, the carrying angle was significantly higher among
was the participant’s age (r = 0.48, p = 0.001). Kushwaha females (12.96±2.44) compared to males (12.19±1.74)
et al. (2022) 21 found that the mean CCA on the left side (p=0.001). There was no significant variation in carrying
was 8.77 + 2.03, and they found this to be significant. The angle observed among different height groups (p>0.05),
RCA on the right side had a mean of 8.85 + 2.09 points. and no significant difference between males and females
The RCA on the left side had a mean value of 9.07 2.13. across age groups or height groups (p>0.05). A significant
242 Khan and Singh / Indian Journal of Orthopaedics Surgery 2023;9(4):237–242

positive correlation was found between age and carrying 13. Khare GN, Goel SC, Saraf SK, Singh G, Mohanty C. New
angle (r=0.48, p=0.001). observations on carrying angle. Indian J Med Sci. 1999;53(2):61–7.
14. Golden DW, Jhee JT, Gilpin SP, Sawyer JR. Elbow range of motion
and clinical carrying angle in a healthy pediatric population. J Pediatr
6. Author Contributions Orthop B. 2007;16(2):144–9.
15. Robinson PM, Griffiths E, Watts AC. Simple elbow dislocation.
a) Conceptualization, Data collection, Manuscript drafting Shoulder Elbow. 2017;9(3):195–204.
and critical revision of the manuscript – Dr. Rakesh Singh; 16. Allouh MZ, Ghaida JHA, Jarrar AA, Khasawneh RR, Mustafa AG,
b) Manuscript drafting, and data collection – Dr. Pankaj Bashaireh KM, et al. The carrying angle: racial differences and
relevance to inter-epicondylar distance of the humerus. Folia Morphol
Singh; c) Manuscript revision and supervision – Dr. Avinash (Warsz). 2016;75(3):388–92.
Dwivedi ; d) Statistical Analysis and data curation – Dr. 17. Dai L. Radiographic evaluation of Baumann angle in Chinese children
Shadab Khan; and e) Supervision and Critical revision of and its clinical relevance. J Pediatr Orthop B. 1999;8(3):197–9.
18. Mohammad S, Rymaszewski LA, Runciman J. The Baumann angle
Manuscript – Dr. Rakesh Singh. in supracondylar fractures of the distal humerus in children. J Pediatr
Orthop. 1999;19(1):65–9.
7. Source of Funding 19. Bhatti U, Sangrasi SA, Effendi S, Ahmadani R, Shaikh SN, Abro
A. An Anthropometric Study on the Carrying Angle of Elbow
Nil. among Children Ages between 10 to 15 Years of Various Schools
in Hyderabad, Pakistan: A Cross-Sectional Study. Annals of RSCB.
2022;26(1):776–81.
8. Conflicts of Interest 20. Sadacharan CM, Alikhan SB, Packirisamy V, Murlimanju BV.
Carrying angle of the elbow joint in young Caucasian and Indian
Nil. American population: A descriptive cross&#8209;sectional study. J
Anat Soc India. 2022;71:42–6.
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