Pediatric Radiology

, Volume 48, Issue 5, pp 749–753 | Cite as

Chronic lesser tuberosity avulsion in an adolescent with an associated biceps pulley injury

  • Daniel J. Mizrahi
  • Lauren W. Averill
  • Steven L. Blumer
  • Arthur B. Meyers
Case Report


We report a case of a 15-year-old boy with chronic intermittent left shoulder pain due to an undiagnosed lesser tuberosity avulsion fracture, an associated biceps pulley injury and intra-articular dislocation of the long head of the biceps tendon. Lesser tuberosity avulsion fractures are rare injuries that are difficult to detect on clinical exam and radiographically, which may lead to delayed diagnosis and chronic shoulder instability. Few reports describe dislocations or subluxations of the biceps tendon in association with lesser tuberosity avulsions in children. We utilize this case to emphasize the importance of MR not only in detecting lesser tuberosity avulsions, but also in evaluating biceps pulley injuries, which are a rarely reported, but clinically important, association.


Adolescent Avulsion Biceps pulley Biceps tendon Fracture Lesser tuberosity Magnetic resonance imaging Shoulder 


Compliance with ethical standards

Conflicts of interest

Dr. Arthur Meyers is an author/editor for Amirsys/Elsevier for which he receives royalties. Drs. Mizrahi, Averill and Blumer have no conflicts of interest to report.


  1. 1.
    Gruson KI, Ruchelsman D, Tejwani N (2008) Isolated tuberosity fractures of the proximal humerus: current concepts. Injury 39:284–298CrossRefPubMedGoogle Scholar
  2. 2.
    Ogawa K, Takahashi M (1997) Long-term outcome of isolated lesser tuberosity fractures of the humerus. J Trauma 42:955–959CrossRefPubMedGoogle Scholar
  3. 3.
    Provance AJ, Polousky JD (2010) Isolated avulsion fracture of the subscapularis tendon with medial dislocation and tear of biceps tendon in a skeletally immature athlete: a case report. Curr Opin Pediatr 22:366–368CrossRefPubMedGoogle Scholar
  4. 4.
    LaMont LE, Green D, Altchek D et al (2015) Subscapularis tears and lesser tuberosity avulsion fractures in the pediatric patient. Sports Health 7:110–114CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Nakata W, Katou S, Fujita A et al (2011) Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics 31:791–810CrossRefPubMedGoogle Scholar
  6. 6.
    Paschal SO, Hutton KS, Weatherall PT (1995) Isolated avulsion fracture of the lesser tuberosity of the humerus in adolescents. A report of two cases. J Bone Joint Surg Am 77:1427–1430CrossRefPubMedGoogle Scholar
  7. 7.
    Vezeridis PS, Bae D, Kocher M et al (2011) Surgical treatment for avulsion injuries of the humeral lesser tuberosity apophysis in adolescents. J Bone Joint Surg Am 93:1882–1888CrossRefPubMedGoogle Scholar
  8. 8.
    Scheibel M, Martinek V, Imhoff AB (2005) Arthroscopic reconstruction of an isolated avulsion fracture of the lesser tuberosity. Arthroscopy 21:487–494CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Daniel J. Mizrahi
    • 1
    • 2
  • Lauren W. Averill
    • 1
    • 3
  • Steven L. Blumer
    • 1
    • 3
  • Arthur B. Meyers
    • 4
  1. 1.Department of Medical Imaging, Nemours Children’s Health SystemA. I. duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Department of RadiologyThomas Jefferson University HospitalPhiladelphiaUSA
  3. 3.Department of RadiologySidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaUSA
  4. 4.Department of Medical Imaging, Nemours Children’s Health SystemNemours Children’s HospitalOrlandoUSA

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