Stress fractures of the humeral shaft
- Rebecca Bassett, MD
Rebecca Bassett, MD
- Adjunct Clinical Assistant Professor
- University of North Carolina School of Medicine
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
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".)
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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- CLINICAL ANATOMY
- EPIDEMIOLOGY AND MECHANISM OF INJURY
- CLINICAL PRESENTATION AND EXAMINATION
- DIFFERENTIAL DIAGNOSIS
- RADIOGRAPHIC FINDINGS
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- INITIAL TREATMENT
- FOLLOW-UP CARE
- RETURN TO SPORTS AND WORK
- SUMMARY AND RECOMMENDATIONS