Injury patterns
Isolated lesser tuberosity fractures in adults
- can be isolated
- often associated with posterior shoulder dislocation
Lesser tuberosity avulsions in adolescents
- skeletally immature
- avulsion of the lesser tuberosity apophysis
Posterior shoulder dislocations and lesser tuberosity avulsions
Isolated lesser tuberosity avulsion
Lesser tuberosity avulsions in adolescents / skeletally immature
Definition
Traumatic avulsion of the lesser tuberosity and subscapularis insertion
- frequently missed on xray
- delayed presentation
Epidemiology
- systematic review of 60 patients
- mean age 13
- sensitivity of xray 16%
- sensitivity of MRI 95%
- 17% successfully treated nonoperatively
Presentation
Previous history of trauma
Anterior shoulder pain
Subscapularis weakness
MRI
CT
Lesser tuberosity can become overgrown
Operative management
Options
Open versus arthroscopic
Fixation methods
- screw fixation +/- soft tissue washer
- suture anchor + screws
- double row suture anchor fixation
Results
- arthroscopic fixation of 15 lesser tuberosity avulsions
- all patients had full ROM and full strength
Technique
JSES open fixation lesser tuberosity PDF
Vumedi arthroscopic fixation lesser tuberosity video
Arthroscopy techniques lesser tuberosity avulsion PDF
Screw fixation
Screw + soft tissue washer
Medial row anchors and lateral screws for missed lesser tuberosity avulsion in adolescent