BACKGROUNDTypically, greater tuberosity fracture of the humerus are described in combination with proximal humeral fractures or in association with shoulder dislocation. 1 -4 According to the AO statistics, less than 2% of all operatively treated proximal humeral fractures were isolated, mildly to moderately displaced fractures of the greater tuberosity. 5 However, undisplaced greater tuberosity fractures of the humerus may be under-diagnosed and therefore be more common than suggested in the literature. 6 Very few similar cases have been reported. More specifi cally, Kaspar and Mandel 7 reported the fi rst case of a full-thickness tear of the rotator cuff associated with an extensive cavitary bone defect in the superolateral proximal humerus. This case was described as "acromial impression fracture of the greater tuberosity with rotator cuff avulsion". More recently, Dodson et al 8 reported complete rotator cuff tendon avulsion and glenohumeral joint incarceration in a young patient. CASE PRESENTATIONThe patient was of 47-year-old, right hand dominant male weighing 70 kg. Other than having tablet-controlled diabetes mellitus, he was fi t and healthy. He was ex-army personnel, having left the service about 17 years previously and experienced nightmares related to his previous army placement. One night, dreaming he was being chased by enemy troops trying to bomb his base, he jumped off his bed and landed with his body weight onto his right upper extremity. Trying to protect his head, he hyper-abducted his right shoulder and as a result, hit his right shoulder against the wall. The next morning, he experienced severe Other full case Acromial impression fracture of the greater tuberosity with massive rotator cuff tear: this need not be a nightmare!