The greater tuberosity, located on the humerus next to the head of the humerus and the lesser tuberosity, is a large, bulbous protrusion from this long arm bone that serves as an attachment point for several muscles. Four of these muscles control movement of the shoulder. As a group, they are referred to as the rotator cuff, which functions to provide the wide variety of movements that the shoulder can perform and to hold the greater tuberosity in place in the complex shoulder joint. When the shoulder becomes dislocated, it often is because the head of the humerus, located next to the greater tuberosity, has slid out of its normal position.
Falling directly on the shoulder can cause a bone fracture to the greater tuberosity, which is located on the "point" of the shoulder. This type of arm injury also occurs about 15 percent of the time when the shoulder is dislocated, or pulled out of position, and is more likely when the dislocation occurs toward the front rather than toward the back. Shoulder dislocation is seen as a result of violent stress to the shoulder joint and sometimes can happen during severe seizures or as a result of sports accidents. The way the bone breaks during this type of injury is why fractures to the greater tuberosity are referred to as shear injuries.
Fractures to this area can require surgical treatment, including placing screws in the bone to hold the fragments in place during healing. Treatment must also allow for movement of the shoulder during healing in order to prevent the joint from freezing and thus losing much of its natural mobility. For this reason, it is vital not only to have proper treatment during healing, physical therapy after the break has healed also is very important.
In many cases, however, fractures of the greater tuberosity heal without surgical intervention because the natural location of the bone in the shoulder joint produces enough pressure to hold any bone fragments in place during the healing period. Doctors in the field of orthopedics often recommend holding the shoulder joint immobile with a sling for several weeks, then a period of physical therapy to restore motion to the joint. If, after this period of healing, there still is weakness or pain in the shoulder, surgery might then be recommended to help the fragments of the greater tuberosity heal properly. Repair to the muscles of the rotator cuff sometimes is necessary as well.
