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
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
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).
- Linn RM, Kriegshauser LA. Ball thrower's fracture of the humerus. A case report. Am J Sports Med 1991; 19:194.
- Brukner P. Stress fractures of the upper limb. Sports Med 1998; 26:415.
- Low BY, Lim J. Fracture of humerus during armwrestling: report of 5 cases. Singapore Med J 1991; 32:47.
- Pehlivan O, Kiral A, Akmaz I, et al. Humeral shaft fractures secondary to throwing. Orthopedics 2003; 26:1139.
- Cervoni TD, Martire JR, Curl LA, McFarland EG. Recognizing upper-extremity stress lesions. Phys Sportsmed 1997; 25:69.
- Ogawa K, Yoshida A. Throwing fracture of the humeral shaft. An analysis of 90 patients. Am J Sports Med 1998; 26:242.
- Branch T, Partin C, Chamberland P, et al. Spontaneous fractures of the humerus during pitching. A series of 12 cases. Am J Sports Med 1992; 20:468.
- DiCicco JD, Mehlman CT, Urse JS. Fracture of the shaft of the humerus secondary to muscular violence. J Orthop Trauma 1993; 7:90.
- Curtin P, Taylor C, Rice J. Thrower's fracture of the humerus with radial nerve palsy: an unfamiliar softball injury. Br J Sports Med 2005; 39:e40.
- Elliott B. Biomechanics and tennis. Br J Sports Med 2006; 40:392.
- Silva RT, Hartmann LG, Laurino CF. Stress reaction of the humerus in tennis players. Br J Sports Med 2007; 41:824.
- Whitaker JH. Arm wrestling fractures--a humerus twist. Am J Sports Med 1977; 5:67.
- Anderson MW. Imaging of upper extremity stress fractures in the athlete. Clin Sports Med 2006; 25:489.
- Jones GL. Upper extremity stress fractures. Clin Sports Med 2006; 25:159.
- Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23:472.
- Lee JC, Malara FA, Wood T, et al. MRI of stress reaction of the distal humerus in elite tennis players. AJR Am J Roentgenol 2006; 187:901.
- 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