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Fractures of the greater tuberosity presenting as rotator cuff abnormality: magnetic resonance demonstration
1Mallinckrodt Institute of Radiology, Washington University, St. Louis, Missouri 63110, USA. reinus@totty.wustl.ed
Background:
To show that magnetic resonance imaging (MRI) can be useful to diagnose radiographically invisible greater tuberosity fractures in patients with clinical presentations suspicious for rotator cuff injury.
Methods:
Six patients with subtle greater tuberosity fractures who were sent for MRI because of possible rotator cuff tear are reviewed (age range, 27-51 years; mean, 40.5 +/- 8.4 years). Five of the patients recount direct trauma to their shoulders, whereas one noticed shoulder pain after a fall in which she fractured her ankle.
Results:
MRI showed an area of edema confined to the greater tuberosity with linear low signal extending through the tuberosity consistent with a fracture in all cases. Although five patients had a complete set of shoulder radiographs before MRI, these were interpreted as normal in all cases. Full-thickness rotator cuff tears were not present in any of the cases. All of the patients were treated conservatively with good results.
Conclusions:
MRI can prevent unnecessary arthroscopy in patients clinically suspected of rotator cuff damage by showing subtle fractures of the greater tuberosity not visible on radiographs.