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Lesser Tubercle of the Humerus

tuberculum minus humeri

The lesser tubercle is a smaller medial projection of the proximal humerus, lying anterior and medial to the greater tubercle with the intertubercular groove between them. The subscapularis tendon inserts on its flat medial surface, covering it almost entirely. It faces anteriorly in neutral rotation and is palpable medial to the coracoid process with the arm in slight external rotation.

Region: Shoulder

Clinical Relevance

Clinical Notes

The lesser tubercle is the critical landmark for subscapularis tendon tears, which originate at the superior footprint margin and extend inferiorly. The lesser tubercle is also the landmark for subcoracoid impingement assessment (TT-TG measurement analogue) and for biceps pulley integrity, as the superior subscapularis insertion and biceps pulley at the lesser tubercle are often torn simultaneously. In total shoulder replacement and hemiarthroplasty, the lesser tubercle relationship to the cut neck determines the version and height of the stem.

Pathology

Common Injuries & Conditions

Subscapularis Tendon Tear

Tearing of the subscapularis footprint from the lesser tubercle, particularly the superior third, produces weakness of internal rotation and a positive belly press and lift-off test, often associated with medialisation of the long head of biceps tendon requiring arthroscopic repair.