Occult fractures of the greater tuberosity of the humerus

Purpose: We studied the highest number of patients with occult fracture of the greater tuberosity of the humerus and we analyzed why fracture was not diagnosed, shoulder function and prevalence of eventually associated rotator cuff tear (RCT), Material and Methods: 24 patients, mean aged 46, with a undisplaced arid initially missed fracture of the greater tuberosity, underwent MR study for the suspect of a traumatic RCT. The average elapsed time from the trauma to our evaluation was of 18 days. During follow-up period (>1 year), shoulder function and self-assessed comfort were documented with use of Constant's score and Simple Shoulder Test (SST). Results: Of the 24 patients, 9 patients showed evidences of cuff tendinosis ; ] 1 of partial (p) RCT (2: subscapularis ; 6: supraspinatus and 3; supraspinatus and infraspinatus). All patients with pRCT were older than 40, At the first evaluation, the average Cotrstant Score was 54% (range 38 to 68) ; SST value was 5/12 (range 240/12). At the follow-up values increased, respectively, to 90% and to 10/12. Symptoms persisted for an average period of 16 weeks. Conclusion: Shoulder injured patients with decreased abduction and external rotation could have a fracture of the greater tuberosity even if x-ray images result apparently negative and above all if they are older than 40. Suspect of fracture is higher if the function of the involved shoulder is clearly compromised. MR images settle any doubt. 45.8% of our patients has partial RCT. Considering the mean age of patients, it is possible that in some cases the cuff tear precedes the trauma. Symptoms persist for an average period of 16 weeks, however, at the final control, Constant Score of these patients, with and without partial RCT, was the same as that of habitually registered in asymptomatic coeval subjects.