Review of Greater Tuberosity Fractures in the Shoulder
Falling directly onto the shoulder often causes fractures of the greater tuberosity of the humerus (upper arm bone). This is called an impaction injury. The greater tuberosity is a bump on the bone.
Several shoulder muscles from the rotator cuff attach to this part of the bone. The rotator cuff is made up of four muscles that surround the head of the humerus. The rotator cuff moves the arm and helps hold the bone in the shoulder socket.
Other injuries such as a shoulder dislocation can also cause greater tuberosity fractures. This type of trauma is called a shear injury. In this review, Dr. Michael S. George from the University of Texas Medical School (Houston, Texas) explains the management of greater tuberosity fractures.
How the fracture occurs and the medical classification of these injuries is discussed. A brief review of the anatomy is provided. Once the diagnosis is made, then treatment is decided.
Range of motion is important to avoid a frozen shoulder. The patient may need a sling to immobilize the shoulder for a few weeks. This is followed by rehab with a physical therapist. Surgery may be needed when pain persists.
Most fractures of the greater tuberosity heal well without surgery. If the shoulder is dislocated, the surgeon can use a special maneuver to put it back in place. The pressure of the humerus up into the socket holds the fracture in place until it heals.
But there may be other injuries to the soft tissue structures around the shoulder. There may be a partial or full tear of the rotator cuff. Sometimes the rim of fibrocartilage around the shoulder is torn. Even after rehab, pain and weakness can occur. Shoulder instability leads to a loss of function.
In such cases, surgery may be needed to repair the damage. If the fracture hasn't healed, then screws, sutures, or wires may be needed to hold the bones in place until healing can take place. Bone fragments may have to be removed.
Rotator cuff repair may be required. The repair can be done arthroscopically or with an open incision. The author reviews the position and procedures used for both surgical methods. Studies to compare the results using these two methods have not been done but are suggested for future investigations.
Michael S. George, MD. Fractures of the Greater Tuberosity of the Humerus. In Journal of American Academy of Orthopadedic Surgeons. October 2007. Vol. 15. No. 10. Pp. 607-613.