Neglected lesser tuberosity avulsion in an adolescent elite gymnast

Abstract

We report the case of a 16-year-old elite gymnast who presented with recurring pain in the left shoulder after training. The athlete recalled an injury to the shoulder 2 years ago. Clinically a localized tenderness to the anterior shoulder and loss of strength and range of motion was noted. Imaging investigation suggested a neglected lesser tuberosity avulsion. The athlete was treated with open excision of the deformed tuberosity and direct repair of the subscapularis to the humeral head. Following a careful postoperative rehabilitation protocol the athlete was able to return to unrestricted gymnastics after 6 months. After surgery the athlete followed a intense rehabilitation program that allowed him to return to sports at 6 months. At 5-years follow-up, the athlete was asymptomatic and competing at an international level. Avulsion fractures of the lesser tuberosity are extremely rare injuries with significant shoulder disability if left untreated. Anatomic repair can yield excellent results, even in neglected cases.

Knotless Arthroscopic Repair of Subscapularis Avulsion Fracture Using a Single Anterior Portal

“… 10 , 17 Delays in management have been associated with worse outcomes, including pain, weakness, loss of motion, nonunion, and associated biceps pathology. 10 , 18 , 19 …”

Conservative treatment of isolated avulsion fracture of the lesser tuberosity of the humerus: A case report

“…The outcome is determined by the functional limitation and the ability of the patient to perform activities of daily living. Epidemiological data are limited as these type of fractures are often neglected [1][2][3] . There are only case reports in the literature and uncertainty whether the outcome would be optimised if an open reduction and internal fixation has been chosen.…”

“…In most of the cases it presents with a posterior dislocation of the shoulder or with a 2 or 3 segment fracture of the humerus 1 . It occurs usually in the younger population as a result of a fall as in our case, epileptic crises, in athletes with an incidence of 0.46/100000 per year (Robinson et al), but epidemiological data are limited [1][2][3] .…”

Ruboxistaurin Reduces Cocaine-Stimulated Increases in Extracellular Dopamine by Modifying Dopamine-Autoreceptor Activity

“…Animals were anesthetized with 5% isoflurane and placed in a stereotaxic frame. A burr hole was drilled where the probe was to be inserted (+1.7 A/P, ±1.4 M/L, -7.5 D/V in reference to bregma) to sample from the nucleus accumbens core 58 . Probes were implanted bi-laterally and measurements for both probes in each animal were averaged for a single replicate.…”