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Greater Tuberosity Fracture

 
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Greater Tuberosity Fracture - November 2, 2005 11:46:00 PM   
PJM

 

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A patient of mine fell onto an outstretched arm and suffered a Greater Tuberosity Fracture 6 months ago. X-Ray revealed minimal displacement.

They were seen by their Doctor day 1. However possibility of fracture was not investigated till the following day when the patient came back with severe pain.

They were then immobilised for 4/52 with PROM beggining at 2/52. AROM commenced after 6 weeks.

At this time AROM was 90 degrees flexion and 30 deg abduction, with blocked/firm type endfeel.

With mobilisation they improved to 70 deg abduction and flexion was ISQ. A month later they were seen by a shoulder specialist and at this point were given a hydrodilatation. This resulted in 90/90 flexion/abduction.

With more mobilisation and another hydrodilatation they are currently at 150/90.

I have read that antomically aligned greater tuberosity fractures heal well in 75% cases.

Does anyone have experience with minimally displaced fractures and what kind of AROM they recovered to?

Also X-Ray has shown good unity with fracture healing and only evidence of supraspinatus ?tendinopathy. This patient has had significant pain in the forearm/axilla and shoulder especially until the second hydrodilatation.
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Re: Greater Tuberosity Fracture - November 3, 2005 7:19:00 AM   
Andrew M. Ball PT PhD

 

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I've got a patient like this right now. He/she is kind of private, so let me ask first about discussing the case in open forum --- otherwise, feel free to e-mail me at DrDrewpt@msn.com and we can chat about it.

Drew

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Andrew M. Ball, PT, DPT, Ph.D.
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Carolinas Rehabilitation

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Re: Greater Tuberosity Fracture - November 3, 2005 11:39:00 AM   
Shill

 

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Outcome is going to depend on whether the supraspinatus is working or not, along with amount of rotation available. Any mention of calcific deposits in the tendinopathy? Ive seen these do well, and also poorly, but the poor outcomes were associated with dysfunctional or injured (torn) supraspinatus and development of capsular restriction during the healing.

Steve

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Steve Hill PT

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Re: Greater Tuberosity Fracture - November 7, 2005 8:14:00 PM   
PJM

 

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Shill,

MRI findings of slightly comminuted greater tuberosity fracture and supraspinatus tendinopathy. Xray reveals good union and minimal displacement in regard to alignment.

(in reply to PJM)
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Re: Greater Tuberosity Fracture - November 8, 2005 11:30:00 AM   
Shill

 

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PJ,
If there is a bony block end feel, (with no capsular tightness yet), you should be able to rotate to 50 degrees of ER with the arm at the side (normal ER for this position), but not when the shoulder is in ABD. I have seen a couple of patients with gt tuberosity fractures, where it just seemed like the tuberosity didnt fit under the acromion anymore, and these were "minimally displaced" as well.
How is this gentleman's rotational ROM? Do you feel that SS is functioning well?
One last question, what does 4/52 mean in your first post? Im not familiar with that nomenclature.

Steve

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Steve Hill PT

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Re: Greater Tuberosity Fracture - November 9, 2005 2:35:00 PM   
treybien

 

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With even minimal comminutation I have found these patients have a tough time and may need some help in the way of a decompression procedure and debridement if they fail to progress.

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Re: Greater Tuberosity Fracture - November 9, 2005 3:21:00 PM   
PJM

 

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Thanks for your replies.

Steve,

By 4/52 I mean 4 weeks. I hope this doesn't sound glib, but his endfeel felt like bony and capsular. His external rotation at 0 degrees elevation is significantly restricted.

Treybien,

I have obviously had a very similar experience to your own. I too get the impression the greater tub. just won't fit under the acromion with abduction, flexion he manages much better with.

I would be interested to know if you have experienced favourable results when decompression and debridement have been done in this type of presentation?

Also I wonder whether his supraspinatus tendinopathy is a result of the injury itself or merely the secondary to immobilisation and subsequent capsular and likely bony restriction.

(in reply to PJM)
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Re: Greater Tuberosity Fracture - November 9, 2005 8:31:00 PM   
Shill

 

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From: Madison WI USA
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PJ,
Not glib at all. These folks and others that develop capsular patterns due to fractures in or around the joint are often extremely challenging. What amazes me more is those shoulders that develop the same pattern, yet without any injury. The "capsulitis" patients. Ive read the literature on it, and no one seems to be able to come up with a reason why these things start. I dont really care how it starts, in all honesty, I just want a better way to treat it that brings about results, consistently.
Good Luck
Steve

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Steve Hill PT

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Re: Greater Tuberosity Fracture - November 10, 2005 9:53:00 AM   
treybien

 

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the most recent patient I had with this problem did very well after decompression and debridment. She had some pre existing shoulder history which made the process of getting her strength back a little tedious but overall she did well. As we often see the MRI showed less supraspinatus damage than was actually there with signifcant lack of subacromial space.

(in reply to PJM)
Post #: 9
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