The shoulder joint is formed where the humeral head — the ball-shaped upper end of the arm bone — connects with the glenoid socket of the shoulder blade. On the outer, lateral side of the humeral head is a bony prominence called the greater tuberosity. This is where the three of the rotator cuff tendons insert. These three muscles pull on the greater tuberosity, allowing you to lift and rotate your arm.

 

A greater tuberosity fracture refers to a break in this specific area of the upper humerus, without involvement of the main humeral head or the shoulder joint. One important concept to remember with this injury, is that activation and pulling of the rotator cuff muscles will displace the fragment upwards or backwards, moving it into a problematic position.

 

Your management largely depends on the position of your greater tuberosity and how it is likely to affect your long-term shoulder function. In most cases, the bony fragment remains close to its normal position, and the fracture can be managed without surgery. A sling is used to rest the shoulder and allow the bone to begin healing in this protected position. People who are managed without an operation should strictly avoid trying to lift their arm, to ensure the greater tuberosity stays in the correct position.

 

You’ll usually be seen in the fracture clinic within one to two weeks of your injury. The orthopaedic surgeon will review your X-rays, and assess whether the fracture remains in a safe position. If the fragment has moved significantly, or if the shoulder function is at risk — a referral to a shoulder specialist or a CT scan may be considered. In a minority of cases, surgery may be recommended to re-position and secure the fragment.

 

For those managed non-operatively, the arm is rested in a sling for around three to four weeks. Although the shoulder should be rested, it's important to keep the hand, wrist and elbow moving on a regular basis to prevent stiffness. X-rays are performed at regular intervals to ensure the bone remains in an appropriate position. Once the initial healing phase is complete — you will usually be referred to the physiotherapy team — who will guide a staged return to overhead movement, strength and shoulder control.

 

Mild discomfort or stiffness is expected in the first few weeks. As you will be unable to effectively elevate your arm, patients often experience significant bruising or swelling, that tracks down the arm and towards the hand.

 

Once the fracture shows signs healing, you’ll be advised to reduce the use of the sling and begin controlled shoulder movements with physiotherapy guidance. Most people can return to desk work and daily activity by around six weeks post-injury, and return to higher-demand and overhead tasks by eight to twelve weeks.

 

Residual aching, especially with reaching or loading the arm, can persist for a few months. To improve your recovery outcomes, it is important to engage well in the rehabilitation of your surrounding rotator cuff muscles, which will be deconditioned after several weeks of dis-use. Performing your physiotherapy exercises regularly — in a self-directed manner — is a key factor towards regaining function.

 

If there is ongoing pain, weakness or reduced range of motion beyond the expected recovery window, you can contact the fracture clinic to arrange a review of your progress and check for any signs of ongoing problems.