The greater tubercle is the prominent lateral projection of the proximal humerus, divided into superior, middle, and inferior facets. The supraspinatus inserts on the superior facet, the infraspinatus on the middle facet, and the teres minor on the inferior facet. It is the lateral boundary of the intertubercular (bicipital) groove and is palpable beneath the anterior deltoid with the arm in slight internal rotation.
| Articulations |
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|---|---|
| Landmarks |
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| Ossification | Ossifies from its own secondary centre appearing at about 2-3 years, which joins the head and lesser tubercle centres at about 5-7 years; the combined proximal epiphysis fuses with the shaft at about 18-22 years. |
The greater tubercle facets are the critical surgical anatomy for rotator cuff repair and anchor placement. Rotator cuff tears most commonly begin at the supraspinatus footprint on the superior facet and extend posteriorly. Footprint restoration is the goal of rotator cuff surgery, assessed by measuring residual medial migration after repair. Greater tubercle fractures occur in anterior shoulder dislocations and require reduction when displaced more than 5 mm as they cause persistent impingement.
Find the outer edge of the acromion and slide just below it onto the upper outer side of the humerus. The broad bony prominence there is the greater tubercle. Placing the person's hand behind the back (extension and internal rotation) brings the front of the tubercle and the supraspinatus insertion forward from under the acromion.
Avulsion or impaction fracture of the greater tubercle in anterior shoulder dislocation or direct trauma causes pain and impingement with arm elevation; displacement greater than 5 mm requires surgical fixation, while undisplaced fractures heal conservatively.
Degenerative tearing of the rotator cuff tendons from their greater tubercle footprint, beginning with the supraspinatus, produces a progressively enlarging full-thickness tear that weakens active shoulder elevation and external rotation, repaired arthroscopically or open with suture anchors to restore footprint contact.
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