Fracture of the Greater Tuberosity of the Humerus

The patient was a 27-year-old male pilot referred to a physical therapist for a suspected left acromioclavicular joint injury following a fall 3 weeks prior. Initial shoulder radiographs ordered by the referring primary care physician at the time of injury were negative for a fracture or dislocation (FIGURE 1, available at www.jospt.org).

Physical examination findings revealed decreased active shoulder flexion (110°) and abduction (45°) due to weakness and pain. Passive shoulder flexion and abduction both measured 160°. Supraspinatus strength was decreased and Hawkins test was positive. Clinical examination for the acromioclavicular joint was negative. There was no deformity present or tenderness to palpation throughout the subacromial or acromioclavicular joint region.

Based on the history and physical examination, shoulder radiographs were ordered by the physical therapist due to the mechanism of injury and physical examination findings. The anterior-posterior radiographic view in external rotation, essential for best visualization of the greater tuberosity of the humerus,¹ showed an incomplete nondisplaced fracture in the superior aspect of the greater tuberosity (FIGURE 2). Although not present in this case, tenderness at the lateral wall of the greater tuberosity is a characteristic finding for this injury.¹ The patient was placed in a sling for 4 weeks and instructed in passive range-of-motion exercises to maintain shoulder mobility.

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At 7 weeks following injury, repeat shoulder radiographs demonstrated a healed greater tuberosity fracture (FIGURE 3). The patient demonstrated full shoulder active range of motion, with very mild pain at end range and normal supraspinatus strength. He completed a shoulder rehabilitation program resulting in return-to-flight status at 12 weeks from the initial injury.

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J Orthop Sports Phys Ther 2010;40(7):447. doi:10.2519/jospt.2010.0411