The greater tubercle is an anatomical process on the humerus, a long bone of the body located in the upper arm. This structure serves as the point of insertion for several muscles in the arm and chest. It is sometimes involved in fractures, most commonly in shoulder dislocations and rotator cuff injuries. Injuries to the greater tubercle are usually treated by an orthopedic doctor, a medical specialist who focuses on caring for the skeleton.
Anatomically, the greater tubercle is positioned laterally to the humeral head, to the side of the bone. The head of the humerus inserts into the shoulder socket while the greater tubercle protrudes to the outside of the shoulder. The structure has a flattened appearance with points for the teres minor, infraspinatus, and supraspinatus muscles to attach. The surface of the structure is roughened. A corresponding structure known as the lesser tubercle forms a ridge on the inside of the humerus.
The greater tubercle is most commonly injured in shoulder injuries where the shoulder is dislocated or tremendous stress is put on the rotator cuff. A sharp blow to the shoulder can also hit this anatomical landmark, leading to a fracture. Fractures of this process are difficult to treat. They usually require surgery as it is challenging to reduce a closed fracture and it can be difficult to fix the fracture in place to allow the bone to heal.
In surgery, a surgeon will typically use screws or pins to fix the greater tubercle in place. Casting may be used to immobilize the arm, or it may be positioned in a sling, depending on other associated injuries, as the greater tubercle is rarely fractured alone. X-rays can be used to follow up on the course of healing and to determine whether additional treatment is needed. The biggest risk with fractures of this bone is necrosis, bone death caused by inadequate blood supply.
People who experience shoulder fractures typically notice them, because the shoulder is often extremely painful, range of motion in the arm may be limited, and the shoulder can appear visibly out of position. It is important to receive prompt treatment for fractures to avoid complications like necrosis. Sometimes fractures are less obvious and the patient may think that persistent shoulder pain is being caused by a strained muscle, rather than a broken bone. If shoulder pain persists despite pain management at home, it is advisable to see a doctor for evaluation.