Lesser Tuberosity Avulsions in Adolescents

HSS Journal Volume 10, Number 3 October 2014

Lorenzo Nardo, MD

Department of Radiology and Biomedical Imaging, University of California, San Francisco

Benjamin C. Ma, MD

Department of Orthopaedic Surgery, University of California, San Francisco

Lynne S. Steinbach, MD

Radiology and Orthopaedic Surgery, University of California, San Francisco

Abstract

Background
Subscapularis tendon avulsions of the lesser tuberosity are relatively rare and often missed acutely and their characteristic appearance is frequently not recognized or is misinterpreted for an osteochondroma or a neoplastic process.

Questions/Purposes
This report reviews our experience with six adolescents who had subscapularis tendon avulsions of the lesser tuberosity.

Methods
Six male adolescents (12–15 years) presented with shoulder pain following history of trauma during amateur sport. Clinical notes including range of motion, strength tests, and pain assessment were reviewed along with imaging studies pre- and post treatment. Treatment consisted of either surgical or conservative measures.

Results
Two of the six patients had a large avulsion that simulated an exostosis of the proximal humerus that was misdiagnosed as an osteochondroma at two different outside institutions. All six cases were diagnosed with subscapularis tendon avulsion of the lesser tuberosity following clinical and imaging evaluation at our institution. Five of the patients underwent surgical repair and fixation of the tendon and the lesser tuberosity with suture anchors. One patient was treated conservatively. All patients had a good outcome with recovery of full shoulder strength and motion upon follow-up.

Conclusion
Clinicians should have a high index of suspicion of lesser tuberosity avulsions in adolescents who present with loss of internal rotation and anterior shoulder pain following traumatic injuries. In addition, an osseous fragment or exostosis along the inferomedial humeral head should suggest a subscapularis tendon avulsion and also should not be confused with an osteochondroma or a neoplastic process.

This work was performed at University of California San Francisco.

Level of Evidence: Level IV Case Series.

This article appears in HSS Journal: Volume 10, Issue 3.
View the full HSS Journal article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

 

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