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.
| Articulations |
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|---|---|
| Landmarks |
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| Ossification | Ossifies from a secondary centre appearing at about 4-5 years that merges with the head and greater tubercle; the combined proximal epiphysis fuses with the shaft at about 18-22 years. |
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.
With the arm by the side and the elbow bent to 90 degrees, place your fingers on the front of the shoulder just below and lateral to the coracoid process. Slowly rotate the arm outward and inward: the smaller bony bump on the inner side of the bicipital groove is the lesser tubercle, where subscapularis attaches.
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.
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