36-year-old patient with history of falling down



Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian


Case Section

Muskuloskeletal System


Patient's Information

Gender : Male
Age : 36


Clinical Summary

36-year-old patient with history of falling down


Imaging Findings

MR imaging demonstrates the fracture line in posterolateral aspect of the humeral head within the greater tuberosity as a irregular low-signal area surrounded by bone marrow edema on T1-weighted sequence(Fig.1).Mild joint effusion (Fig.4,6,red arrow) with extension to the fracture line (Fig4,blue arrow) and also bicipital tendon sheet(Fig5,7) is noted.Focal areas of high-signal intensity changes within the bicipital (long head) tendon on T2-weighted and PD sequences are depicted,indicative of intratendinous tear of bicipital tendon.The rest of rotator cuff and the labra are intact.


Differential Diagnosis



Final Diagnosis

Minimally displaced greater tuberosity fracture


Discussion (Related Text)

Most fractures about the shoulder are adequately evaluated with plain radiography. In cases of complex fractures of the proximal humerus, CT may be helpful for pretreatment planning.Treatment of these fractures varies considerably depending on their position in the widely used classification scheme of Neer.This scheme is based on the degree of separation or rotation of the four possible major fracture fragments (shaft, head, greater tuberosity, and lesser tuberosity). A fragment is considered displaced if it is distracted 1 cm or more from its neighbors or if it is angulated 45 degrees or more from its proper location.Fractures without displacement are commonly treated with early mobilization, whereas those involving displacement of one of the tuberosities often require open reduction. It is important, therefore, to determine accurately the position of all fragments before definitive treatment is carried out. This may be difficult with plain radiographs alone.



Haaga J: CT and MR imaging of the whole body, 5th ed. Philadelphia: Mosby, 2009.


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