Management of a patient with an isolated greater tuberosity fracture and rotator cuff tear.
METHODS
Case report.


BACKGROUND
Patients with hyperflexion/hyperabduction injury to the glenohumeral joint are at risk for isolated greater tuberosity fractures, which are often undiagnosed or misdiagnosed. In this case report, we describe the clinical decision-making process that led to the diagnosis of an isolated greater tuberosity fracture and subsequent rotator cuff tear.


METHODS
The patient was a 45-year-old male who sustained a shoulder injury as the result of a fall while skiing. After the initiation of physical therapy, he was diagnosed with an isolated greater tuberosity fracture. Little is known regarding the optimal management and overall prognosis of this type of fracture. Conservative nonoperative management and postoperative physical therapy management are discussed.


RESULTS
With conservative nonoperative management, the patient was unable to regain high-level functional shoulder use. Suspicion of continued pathology of the greater tuberosity dictated further diagnostic imaging, which led to surgical intervention. Upon completion of postoperative rehabilitation, he was able to resume full recreational activities.


CONCLUSIONS
It is recommended that sound clinical decision-making dictate the management and ongoing evaluation of traumatic shoulder injuries, especially when managing a patient with an injury for which optimal treatment and prognosis is not well established.
Wilcox
Reg B
RB
Outpatient Services, Department of Rehabilitation Services, Brigham and Women's Hospital, Boston, MA 02115, USA. rwilcox@partners.org
Arslanian
Linda E
LE
Millett
Peter J
PJ
D001265:Athletic Injuries / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010348:Patient Care Team; D010808:Physical Examination / Q000379:methods; D026741:Physical Therapy Modalities; D026761:Physical Therapy Specialty; D011859:Radiography; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012784:Shoulder Fractures / Q000175:diagnosis / Q000534:rehabilitation* / Q000601:surgery; D012865:Skiing / Q000293:injuries; D016896:Treatment Outcome