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Greater tubercle of humerus

The greater tubercle of the humerus (also called the greater tuberosity) is a large, rounded lateral projection from the proximal humeral shaft. It forms the lateral contour of the shoulder and serves as the primary insertion site for three rotator cuff tendons — supraspinatus, infraspinatus, and teres minor — playing a vital role in shoulder stability and motion.

It lies lateral and posterior to the lesser tubercle, separated by the intertubercular (bicipital) groove that transmits the tendon of the long head of the biceps brachii. The tubercle’s facets are organized to accommodate the rotator cuff tendons and act as the bony anchor point for humeral rotation and abduction.

Synonyms

  • Greater tuberosity of humerus

  • Major tubercle

  • Lateral humeral tuberosity

Location and Structure

  • Position: Lateral aspect of the proximal humerus, superior to the surgical neck, lateral to the intertubercular groove.

  • Shape: Prominent, convex bony eminence projecting laterally and posteriorly.

  • Facets:

    • Superior facet: Insertion of the supraspinatus tendon.

    • Middle facet: Insertion of the infraspinatus tendon.

    • Inferior facet: Insertion of the teres minor tendon.

  • Composition: Compact cortical bone externally with fatty trabecular marrow centrally.

Relations

  • Superiorly: Subacromial bursa and deltoid muscle.

  • Anteriorly: Lesser tubercle and intertubercular groove (with biceps long head tendon).

  • Posteriorly: Capsule of the glenohumeral joint and rotator cuff tendons.

  • Laterally: Deltoid muscle and subdeltoid bursa.

  • Medially: Humeral head and neck region.

Muscular Attachments

  • Supraspinatus: Inserts onto the superior facet; initiates abduction of the arm.

  • Infraspinatus: Inserts onto the middle facet; responsible for external rotation.

  • Teres minor: Inserts onto the inferior facet; assists in external rotation and adduction.

  • The joint capsule of the shoulder also attaches along its margins, contributing to stability.

Nerve Supply

  • Supplied indirectly through the periosteum by:

    • Suprascapular nerve (via supraspinatus and infraspinatus tendons)

    • Axillary nerve (via teres minor and deltoid attachments)

Function

  • Attachment point: Provides insertion for three rotator cuff muscles, essential for dynamic stability.

  • Leverage: Acts as a mechanical lever for abduction and external rotation.

  • Joint stability: Anchors the rotator cuff, compressing the humeral head into the glenoid fossa.

  • Movement control: Assists in precise shoulder movements, particularly lifting and rotation.

Clinical Significance

  • Fractures: Greater tubercle fractures occur in falls or shoulder dislocations; can cause impingement or rotator cuff dysfunction.

  • Rotator cuff tendinopathy: Common at the supraspinatus insertion, visible as cortical irregularity or sclerosis.

  • Calcific tendinitis: Calcium deposition near the superior facet leads to pain and restricted motion.

  • Osteolysis: Repetitive microtrauma or rotator cuff tears may cause cortical resorption.

  • Imaging importance: MRI and CT are essential for evaluating tendon attachment integrity, bone marrow edema, and cortical changes.

MRI Appearance

  • T1-weighted images:

    • Cortex: Low signal (dark).

    • Bone marrow: Bright, due to fatty content.

    • Rotator cuff tendons: Low signal, inserting along distinct facets.

    • Bursal fat and soft tissue: Bright, highlighting adjacent inflammation if present.

    • Fractures: Appear as linear low-signal lines crossing cortex with surrounding bright marrow signal from edema.

  • T2-weighted images:

    • Cortex: Low signal.

    • Marrow: Bright, slightly less than on T1 but still hyperintense relative to muscle.

    • Cartilage and tendons: Low signal bands overlying the bone.

    • Pathology:

      • Edema or bone contusion: bright hyperintense signal.

      • Tendinopathy: increased signal at tendon insertion (especially supraspinatus).

      • Calcific deposits: appear dark within high-signal edema zones.

  • STIR:

    • Normal marrow: Intermediate-to-dark signal.

    • Pathologic marrow: Bright hyperintense in bone edema or fracture.

    • Tendon tears or bursitis: Hyperintense signals in peritendinous regions or subacromial space.

  • Proton Density Fat-Saturated (PD FS):

    • Normal bone: Intermediate-to-dark signal.

    • Pathology: Bright hyperintense areas in bone or soft tissue (edema, tendon tear, bursitis).

    • Excellent for distinguishing partial- vs. full-thickness rotator cuff tears.

  • T1 Fat-Sat Post-Contrast:

    • Normal bone: Homogeneous mild enhancement.

    • Inflamed or repaired tendon insertions: Show peripheral enhancement.

    • Osteomyelitis or neoplasm: Irregular marrow enhancement with cortical disruption.

    • Postoperative scars: Peripheral enhancement with central low signal fibrosis.

CT Appearance

Non-Contrast CT:

  • Cortex: High attenuation, sharply defined contour.

  • Trabecular bone: Fine spongy structure with fatty marrow spaces.

  • Facets: Clearly visualized as shallow impressions for rotator cuff attachments.

  • Pathology:

    • Detects avulsion fractures, cortical sclerosis, and calcific tendinitis.

    • Rotator cuff tears may appear as cortical irregularity or cystic change at insertion.

Post-Contrast CT (standard):

  • Bone: Minimal enhancement.

  • Periosteum or soft tissue: Enhances in inflammation or infection.

  • Utility:

    • Defines fracture patterns and healing.

    • Evaluates post-traumatic osteolysis, cortical resorption, and post-surgical hardware alignment.

CT VRT 3D image

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CT VRT 3D image

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MRI image

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CT image

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