Presentation
Road traffic accident resulting in femur fracture six weeks back. Loss of shoulder abduction, external rotation since the trauma.
Patient Data
There is a large bony avulsion fracture involving middle and inferior facets of the humeral greater tuberosity which are footprints of the infraspinatus and teres minor tendons respectively. The fragment is about 23 mm in length. It is retracted for 35 to 40 mm from the humerus head defect. Intact infraspinatus and teres minor tendons are attached to the avulsed fragment.
Superior facet the humeral greater tuberosity is intact with intact supraspinatus tendon inserted into it. Lesser tuberosity of the humerus is intact with the intact subscapularis tendon inserted into it. Biceps long head tendon shows normal location and echopattern.
No effusion of the subdeltoid-subacromial bursa/ glenohumeral joint.
A comparison with the asymptomatic side was done which shows normal greater tuberosity of the right humerus head.
1st cine-loop is aligned to the short-axis of the infraspinatus and teres minor muscle, directed from lateral to the medial side. 2nd cine-loop runs from medial to lateral direction. 3rd loop is aligned to the long-axis of muscles.
The drawing represents the ultrasound findings which are avulsion of the middle and the inferior facets of the humeral greater tuberosity with intact tendons attached to them.
Case Discussion
Case shows humeral head greater tuberosity avulsion fracture involving middle and inferior facets with the intact rotator cuff.
The fracture was not apparent on the shoulder radiograph (no copy-right, not uploaded) which is not an uncommon occurrence. Bony avulsion injuries are more common in young adults than tendon tears as in this case. Isolated avulsion of the humeral greater tuberosity is an uncommon pathology and isolated avulsion of the humeral lesser tuberosity is rare2.
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