Understanding Fracture of the Greater Tuberosity: Causes, Symptoms, and Treatment

What is the Greater Tuberosity?

The greater tuberosity is a large, bony prominence located at the top of the humerus. It is the attachment point for muscles important for shoulder movement. This includes the rotator cuff muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles help control arm motion and stabilize the shoulder joint.

A fracture in this part of the humerus can affect how these muscles work. This can cause pain, weakness, and a limited range of motion in the shoulder.

Causes of Greater Tuberosity Fractures

The most common cause of a greater tuberosity fracture is a traumatic injury, often resulting from falls or accidents. Here are some of the main causes:

• Direct Impact or Trauma: A direct blow to the shoulder, such as during a fall or a car accident, can cause the greater tuberosity to fracture.
• Sports Injuries: Athletes who engage in contact sports or activities that involve overhead movements, such as football, basketball, or tennis, are at a higher risk for shoulder injuries, including greater tuberosity fractures.
• Osteoporosis: In older individuals, the bones can become weakened due to osteoporosis, making them more susceptible to fractures even from minor trauma.
• Repetitive Stress: Overuse injuries, particularly in athletes who perform repetitive overhead movements (like pitchers or swimmers), can weaken the bone over time, making it more likely to fracture.

Symptoms of a Greater Tuberosity Fracture

A greater tuberosity fracture can present with several noticeable symptoms, which may include:

• Severe Shoulder Pain: Pain at the top or side of the shoulder, which may worsen with movement or touch.
• Swelling and Bruising: Swelling around the shoulder joint, often accompanied by bruising that can extend down the arm.
• Limited Range of Motion: Difficulty lifting the arm or moving it freely, especially overhead, due to pain or muscle weakness.
• Muscle Weakness: Weakness in the shoulder muscles, particularly the rotator cuff muscles, which can be impaired by the fracture.
• Tenderness: Tenderness when touching the greater tuberosity area.

If you experience any of these symptoms following an injury, it is essential to seek medical attention promptly to diagnose and treat the condition.

Diagnosis of Greater Tuberosity Fracture

To diagnose a greater tuberosity fracture, healthcare providers will begin with a physical examination to assess the shoulder’s range of motion and tenderness. They may also perform imaging tests, such as:

• X-rays: X-rays can help confirm the presence and location of the fracture.
• MRI or CT scans: Sometimes, an MRI or CT scan is needed. These scans help show the soft tissues around the shoulder. They also help assess how serious the rotator cuff injury is. This injury is common with greater tuberosity fractures.

Treatment for Greater Tuberosity Fractures

Treatment for a greater tuberosity fracture depends on the severity of the injury, the patient’s age, activity level, and overall health. The primary goal is to restore shoulder function and relieve pain.

1. Non-Surgical Treatment:

• Rest and Ice: Resting the shoulder and applying ice can help reduce swelling and pain in the early stages after the injury.
• Pain Management: Over-the-counter pain medications, such as ibuprofen or acetaminophen, may be recommended to manage pain and inflammation.
• Physical Therapy: Once the acute pain subsides, physical therapy is often recommended to restore strength and mobility to the shoulder joint. Strengthening the rotator cuff muscles is crucial for recovery.

1. Surgical Treatment:

• Open Reduction and Internal Fixation (ORIF): If the fracture is displaced or the greater tuberosity is significantly misaligned, surgery may be required to reposition the bone and secure it with screws or plates.
• Arthroscopic Surgery: In some cases, minimally invasive arthroscopic surgery may be used to treat smaller fractures or to repair associated soft tissue injuries, such as tears in the rotator cuff muscles.

Recovery and Rehabilitation

The recovery time for a greater tuberosity fracture can vary depending on the severity of the injury and the type of treatment required. Non-surgical treatment typically takes a few weeks to a few months for the bone to heal. However, surgery may require a longer recovery period.

Rehabilitation plays a critical role in recovery. A physical therapist will guide the patient through a series of exercises to strengthen the shoulder muscles, improve range of motion, and restore function. Full recovery can take a few months. Returning to sports or intense activities may take 4 to 6 months or longer.

Preventing Greater Tuberosity Fractures

While some causes of greater tuberosity fractures, such as falls or accidents, cannot be prevented, there are steps individuals can take to reduce their risk:

• Strengthen the Shoulder Muscles: Regular exercises to strengthen the shoulder, particularly the rotator cuff muscles, can help prevent injuries.
• Use Protective Equipment: Athletes should wear proper protective gear during sports to minimize the risk of shoulder injuries.
• Maintain Bone Health: Ensuring adequate intake of calcium and vitamin D can help strengthen bones, particularly in older adults, reducing the risk of fractures due to osteoporosis.

Conclusion

A fracture of the greater tuberosity can be a painful and disabling injury, but with the right diagnosis and treatment, many individuals can recover fully and regain their shoulder function. Whether treated conservatively with physical therapy or through surgery, proper care and rehabilitation are crucial to recovery. If you think you have a greater tuberosity fracture, see a healthcare professional. They can help you get the right treatment for your condition.