DIAGNOSIS:
Displaced Avulsion Fracture of the Supraspinatus Insertion
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| Fig. 2: T2W oblique coronal MRI shows the avulsed greater tuberosity fragment (red arrow) attached to the supraspinatus tendon. |
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The plain radiograph shows an avulsed fragment of bone subjacent to the acromion process with a corresponding defect at the greater tuberosity. The MRI (Fig. 2) shows the avulsed fragment attached to the supraspinatus tendon.
Isolated fractures of the greater tuberosity account for approximately 20% of all proximal humeral fractures. There are typically two mechanisms of injury for a greater tuberosity fracture: impaction or avulsion injury. The impaction injury is usually the result of a fall with forced hyperflexion or hyperabduction of the shoulder. In comparison, an avulsion injury occurs in association with glenohumeral dislocation and has been found to occur in 15% to 30% of dislocations.
Patients with greater tuberosity fractures can present with similar symptoms as patients with rotator cuff injuries and an undisplaced fracture often not visible on radiographs may be misdiagnosed as a rotator cuff injury. The early use of MRI however allows for an accurate diagnosis of the fracture, which assists the therapist and surgeon to structure a conservative treatment plan that would allow for adequate healing.
Avulsion fracture of greater tuberosity of humerus can occur with/ without rotator cuff injury. When undisplaced, conservative management is all that is necessary. Surgical fixation is considered in active patients with > 3 mm displacement. In the general population, greater than 5 mm displacement is the criterion for surgical planning
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