Occult fractures of the greater tuberosity of the humerus

Abstract

We studied the highest reported number of patients with occult fracture of the greater tuberosity of the humerus and we analysed why fracture was not diagnosed, shoulder function and prevalence of eventually associated rotator cuff tear (RCT). Twenty-four patients with a missed fracture of the greater tuberosity underwent MR study for a suspect RCT. We evaluated shoulder function and self-assessed comfort with the Constant score (CS) and Simple Shoulder Test (SST). Nine patients showed evidence of cuff tendinosis, 11 of partial (p) RCT (2: subscapularis; 6: supraspinatus and 3: supraspinatus and infraspinatus). All patients with pRCT were older than 40. Initially, the mean CS and SST were 54% and 5/12; at follow-up, values increased to 36% and 5 points. MR should be performed in patients apparently negative for fracture but with painful shoulders and decreased ROM. Of our patients, 45.8% had pRCT; nevertheless function recovery was verified in 16 weeks.

Prevalence of associated injuries after anterior shoulder dislocation: a prospective study

“…It is known that MRI is the most sensitive imaging modality for detection of accompanying hidden capsuloligamentous injuries, such as Bankart and SLAP lesions, as well as relevant RCT [10,11]. Gumina et al [12] recommended MRI examination for all patients with unexplained persistent painful shoulder with negative radiological findings after shoulder trauma.…”

Greater Tuberosity Fracture of the Humerus

“…Although plain radiographs are usually adequate for identifying this pathology, there is potential for a nondisplaced fracture to be missed ( Gumina et al, 2009 ;Mattyasovszky et al, 2011 ;Rouleau et al, 2016 ). With appropriate clinical examination and suspicion, the advanced practice provider should obtained advanced imaging in the form of magnetic resonance imaging or computed tomography ( Fahmy et al, 2011 ;Gumina et al, 2009 ).…”

“…With these fi ndings, it was recommended that the patient have an magnetic resonance image of the shoulder to evaluate for occult fracture versus a complete rotator cuff tear ( Gumina et al, 2009 ). Magnetic resonance images were obtained and revealed the presence of an isolated, nondisplaced greater tuberosity fracture (see Figure 2 ).…”

“…The mechanism of injury is commonly reported as a fall. Radiographs are standard in the workup of shoulder pain after a fall but may fail to identify an isolated, nondisplaced fracture, given the presence of bony overlap or inadequate positioning ( Gumina, Carbone, & Postacchini, 2009 ;Mattyasovszky et al, 2011 ). In cases in which radiographic fi ndings are not evident, the advanced practice provider needs to consider advanced imaging of the shoulder to assess for an occult fracture or other underlying process such as a rotator cuff tear ( Fahmy, Antonakopoulos, & Khan, 2011 ;Mattyasovszky et al, 2011 ).…”

İzole humerus tüberkulum majus kırıklarında tedavi sonuçları [Treatment results in isolated humerus majus fractures]

“…Bu mekanizmada kırık muhtemelen tuberkulum majusun glenoide impakte olması veya rotator manşetin çekmesi sonucu meydana gelmektedir. 2 Bu kırıkların %95 den fazlası nondeplase veya minimal deplase olup konservatif yöntemle tedavi edilebilmektedir. 3,4,5 Bu çalışmada konservatif ya da cerrahi yöntemle tedavi edilen izole TM kırıklarının sonuçları incelendi.…”