MRI of Greater Tuberosity Avulsion Fracture

A greater tuberosity avulsion fracture is a type of shoulder injury where the greater tuberosity of the humerus is forcibly detached or fractured. This can occur due to direct trauma or indirectly through muscular contraction.

Causes

Greater tuberosity avulsion fractures are most commonly associated with:

• Direct trauma: Such as a fall on an outstretched arm or a direct blow to the shoulder.
• Indirect trauma: This can happen from sudden, forceful lifting or pulling movements, often during sports or strenuous activities.

Symptoms

The primary symptoms of a greater tuberosity avulsion fracture include:

• Pain: Especially when lifting the arm or during shoulder movements; the pain can be severe and is often localized at the top and outer side of the shoulder.
• Swelling and tenderness: Around the shoulder, particularly over the greater tuberosity.
• Reduced range of motion: Difficulty in raising the arm sideways or rotating it, often due to pain and mechanical blockage by the displaced bone fragment.
• Audible pop or snap: In some cases, there might be an audible sound at the time of injury.
• Weakness: In the shoulder, especially when trying to lift or rotate the arm.

Diagnosis

Diagnosis typically involves a combination of clinical examination and imaging studies:

• Physical examination: To assess pain, tenderness, range of motion, and strength in the shoulder.
• X-rays: Are the primary imaging tool used to confirm the presence of a fracture and to evaluate its location and severity.
• MRI: May be used if the involvement of soft tissue, such as rotator cuff tendons, is suspected or to assess the integrity of the surrounding structures.

Treatment

Treatment of greater tuberosity avulsion fractures depends on the size of the bone fragment and the degree of displacement:

• Non-surgical treatment: Includes rest, ice, and immobilization of the shoulder with a sling. Pain management often involves analgesics and anti-inflammatory medications. Physical therapy is crucial and begins with gentle range-of-motion exercises, gradually progressing to strengthening exercises once healing allows.
• Surgical treatment: May be required for large displacements or if the fracture disrupts shoulder function significantly. Surgery typically involves reattaching the bone fragment with screws or other fixation devices and repairing any associated rotator cuff injuries.