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Stress fractures of the humeral shaft

Author
Rebecca Bassett, MD
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

Humeral stress fractures seldom occur, but there are case reports, particularly among overhead athletes, weightlifters, gymnasts, and rowers. The management of stress fractures of the humeral shaft will be reviewed here. Nonstress humeral fractures are discussed separately. (See "Midshaft humeral fractures in adults" and "Proximal humeral fractures in adults".)

CLINICAL ANATOMY

The humerus is the largest bone in the upper extremity (figure 1 and figure 2). The proximal humerus articulates with the glenoid of the scapula to form the shoulder joint. The distal humerus articulates with the radius and ulna at the elbow (figure 3). Shoulder anatomy is complex and discussed in greater detail separately. (See "Evaluation of the patient with shoulder complaints", section on 'Anatomy and biomechanics'.)

The greater tuberosity, located lateral to the humeral head on the proximal humerus, provides the attachment for three of the rotator cuff muscles: supraspinatus, infraspinatus, and teres minor (figure 4). The lesser tuberosity, located on the anterior surface of the proximal humerus, provides the attachment for the subscapularis muscle. For the purposes of fracture classification, the lesser tuberosity marks the boundary between the proximal humerus and the midshaft.

The humeral shaft supplies the attachment for a number of powerful muscles. The pectoralis major muscle inserts on the proximal shaft, while the deltoid muscle attaches to the midshaft. The biceps brachii and triceps muscle groups attach distally.

The tendon of the long head of the biceps brachii muscle passes between the lesser and greater tuberosities as it courses from its origin on the superior portion of the glenoid to its insertion on the proximal radius (figure 5).

          

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Literature review current through: Nov 2016. | This topic last updated: Mon May 30 00:00:00 GMT+00:00 2016.
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