Avulsion of the greater tuberosity

The greater tuberosity is critical for rotator cuff function and therefore shoulder stability.

Surgery may be required for a displaced greater tuberosity fracture to optimize shoulder rehabilitation.

The greater tuberosity serves to improve deltoid muscle function (deltoid wrapping) and as the attachment for the posterior rotator cuff.

Surgery may be required for a displaced greater tuberosity fracture to optimize shoulder rehabilitation.

Fracture of the greater tuberosity can occur by distraction or avulsion:

• During surgery, eg, during dislocation of a trial reverse total shoulder replacement
• During postoperative rehabilitation

• Pain around the shoulder
• Decreased active motion
• Loss of active external rotation
• Positive external rotation lag sign and Hornblower sign

Plain x-rays, particularly the scapular Y view, can demonstrate the fracture, especially in displaced cases. CT is recommended in suspected fractures and to evaluate displacement.