If you have a greater tuberosity fracture (in the Humerus) and are wondering about the rehabilitation process, healing and recovery time, potential complications, and immobilisation period, it’s completely normal to have these questions.
In this article. I have compiled answers to the most common questions from patients I see in x-ray and online regarding greater tuberosity fractures.
To provide these answers, I draw upon my knowledge as a diagnostic radiographer, as well as findings from medical scientific publications.
Happy reading!😀and feel free to ask questions in the comments or share your own experience.🙏
Last updated: May, 2025. Written by Juliet Semakula, a diagnostic radiographer.
▶️ Where do we find the greater tuberosity bone on a shoulder?
The greater tuberosity is a bony prominence on the upper humerus where several key muscles attach, including the supraspinatus and infraspinatus (parts of the rotator cuff).
Image showing a greater tuberosity bone
X-ray image showing the superior aspect of the greater tuberosity bone (arrow).
▶️What does a great tuberosity fracture look like?
A greater tuberosity fracture is a break in the prominent bump on the upper part of the humerus (upper arm bone).
Most of the time this kind of injury causes pain, swelling and very limited range of movement in the shoulder.
They are commonly seen in older people with osteoporotic bone following a fall on an outstretched arm.
X-ray Image of a greater tuberosity fracture of the shoulder which is un-displaced (Nóbrega Catelas 2024)
▶️How is a greater tuberosity fracture treated?
Treatment for greater tuberosity fractures will depend on how displaced your fracture is and other injuries associated with it such as muscles, ligaments, fractures and your general health.
But normally treatment is nonsurgical, but surgery may be necessary in some cases.
Your doctor will be able to let you know what kind of treatment you need after a diagnosis.
Conservative treatment options:
🟠Immobilization: You will be given a sling to help hold and mobilise your fracture to promote healing.
This is usually worn for 4 to 6 weeks, you may need to wear it more as per your doctors’ instructions.
🟠Pain management medication to help with your pain, your doctor will prescribe you pain medication if you need it.
🟠Rest: you will be advised to rest your arm and shoulder in the first 24 to 72 hours of the injury, this will help reduce pain and swelling.
🟠Cold packs applied to the injury help with swelling and pain.
🟠Rehabilitation by encouraging early range of motion exercises using your hands, wrists and elbow.
Surgical management options
When surgery is needed there are usually three options I have seen being done in theatre.
1️⃣An anchor repair is when surgical instruments are inserted through small incisions to repair the fracture.
2️⃣Interfragmentary screw, here two or one screw is inserted to hold the displaced fracture.
3️⃣Locking plate fixation using open reduction fixation.
If your fracture is severely displaced and it is associated with a rotator cuff tear or if the non-surgical treatment fails to achieve adequate healing.
Then surgery will be implemented, x-ray images below show the three different types of surgical management.
X-ray showing surgical management of the greater tuberosity fractures in the proximal humerus. (A) Anchor repair. (B) Interfragmentary screws. (C) Locking plate fixation. Image from (Nóbrega Catelas 2024)
Surgery does not result in a better outcome than conservative management. Based on some medical studies it is likely to result in a greater need for later surgery due to possible complications.
▶️What are possible complications of a greater tuberosity fracture surgery?
When you have had a greater tuberosity fracture there may be other potential complications that hinder quick recovery especially after surgery.
The main complications after greater tuberosity fractures are:
🔴Long-term stiffness and sometimes pain
A study that was done of over 39 patients who underwent surgery of the greater tuberosity fractures from 2010 to 2014 (Nóbrega Catelas,2024)
Identified long term outcomes post-surgical complications that occurred in over 21% of patients.
🔴There is a possibility of anchor failure.
🔴Axillary nerve neuropraxia
🔴Slight reduction loss of movement.
🔴Plate impingement (plate being too high)
🔴Interfragmentary screw failure.
🔴Greater tuberosity resorption and supraspinatus rupture after initial treatment with an interfragmentary screw
Nóbrega Catelas,2024
Conclusion from this study:
Both interfragmentary screws and anchor repair appear to be viable options for greater tuberosity fixation
Usually, surgeons are careful, and their selection is paramount, so such complications are very rare.
Interfragmentary screws appear to be more suitable for male and younger patients with better bone standard and split-type fractures.
while anchor repair may be preferable for female and older patients, with avulsion-type fractures and/or poorer bone standard.
This study was very limited given the relatively low incidence of greater tuberosity fractures requiring surgical treatment.
I believe a future multicentric study would help further comprehend long-term results in these patients and determine the optimal surgical approach for each specific case.
Take home: whatever treatment you get whether non-surgical or surgical, healing takes 8 to 12 weeks, and you will be able to return to your normal activities like before the fracture.
▶️Greater tuberosity fracture rehabilitation protocol
Whether you have had surgery or not there is a rehabilitation program that you will be given to help with your healing.
The rehabilitation plan will always be tailored to your individual needs and the aim is to obtain good healing.
This is divided into three phases
1️⃣Immobilisation during the first few weeks
You will be given a sling to wear for almost 6 weeks or more depending on how your fracture is healing. It will help support your arm and promote healing.
During this phase it is important to limit stiffness in the wrist, hand and elbow when wearing the splint, you can use your fingers and move them regularly as well as your hand.
See simple exercises of hand, wrist and elbow in this article. Dislocated shoulder.
2️⃣Gentle exercises usually begin in week 4 to 6
In the weeks after treatment and once healing is achieved, you will be encouraged to do simple movement exercises with your hand, wrist and elbow to prevent stiffness.
At this point your shoulder can gradually be solicited again, in position to regain good mobility in the fractured shoulder, as well as other joints. but try to avoid heavy lifting or overhead movements.
3️⃣Progressive strengthening.
Week 3: you may be encouraged to start gentle exercises like squeezing a soft ball to help improve strength in your arm.
Week 4-6: you will gradually increase the range of motion exercises but try to avoid heavy lifting or overhead movements.
Week 6: here you will be encouraged to increase your activity exercises levels.
You may be given a follow up appointment in week 6 with your doctor or physiotherapist to monitor your healing progress. This will help determine if you need to adjust the rehabilitation plan as needed.
It is often better to practice these exercises for a short period of time, several times a day for a few seconds, than for 30 minutes 3 times a week.
▶️How long does pain last after a greater tuberosity fracture?
Pain following a greater tuberosity fracture can vary, but it generally decreases within the first 2-3 weeks.
By week 6 you will feel a significant improvement, Mild pain might persist for up to 6 weeks or more
This does not necessarily indicate a problem if the pain does not interfere with sleep.
Usually, your doctor who made the diagnosis will have also prescribed pain medications to help relieve pain.
During rehabilitation, pain may also return but this is a good indicator for gradually resuming shoulder movements
Full recovery, including regaining full range of motion and strength, can take 6-12 months, with some experiencing stiffness and pain for even longer.
Normally, rest and follow your doctors’ instructions, pain medication can help with your pain, which will eventually disappear completely or more in some people.
▶️How long do you have to wear a sling or splint for a greater tuberosity fracture?
First, let’s understand the reason why a sling or splint is prescribed after you have had a greater tuberosity fracture.
A sling helps to immobilise the fractured area, and to limit unnecessary movement of the shoulder, allowing the bone to heal properly.
Your doctor or the orthopaedic team may provide individualized advice on the length of time you need to wear the sling, as it can vary depending on the severity of the fracture and your individual healing progress
Usually, you will be instructed to keep it on for the first 6 weeks when you have just fractured your greater tuberosity.
Usually, a follow up x-ray can be taken to ensure proper healing and the absence of secondary displacement.
Your physiotherapist will tell you when you can start removing the splint, gradually.
It is advisable to wear the sling or splint all the time including bed at night because it helps limit movement when you sleep. You may find it more comfortable to sleep propped up on pillows or upright on a chair.
The sling or splint can only be removed provided that the shoulder is not moved, by keeping the arm and forearm against the body and without moving.
The only time you may take it off is when:
🟢You are taking a wash, leaving the arm either along the body or flexed against oneself.
🟢Dressing using the good arm, make sure you put your injured arm into your clothes first. When you have dressed your upper body remember to place your arm back into the sling.
🟢When resting during the day without sleeping
🟢When sitting still for a while without moving, provided the arm is not moved or during exercises when you are at the stage of rehabilitation.
These moments of rest without a splint or sling are also important to avoid stiffness in the elbow and pain in the neck and upper back from being in the same position all the time.
▶️ Which sling or splint to use and how to properly wear it?
I have seen different types of slings, splints and braces in my hospital setting and in pharmacies, whatever your doctor recommends, usually all of them are positioned using the same principle illustrated below.
♦️The elbow must be flexed at 90 Degrees, position the arm bent, the forearm resting against the belly. I have seen some people tighten the splint too much and bend it further.
This is not ideal as it can cause pain and too much stiffness in the elbow without better immobilising the shoulder.
♦️The straps of the splint should not be against or around the neck, but on the shoulders, as far away from the neck as possible
This avoids neck pain or stiffness, allowing the weight of the immobilised arm to be carried by the back not the neck.
Images showing how best you can position the sling
The immobilization for a greater tuberosity fracture should be done with the elbow flexed at 90°. The splint should be positioned so that it is not wrapped around the neck but rather passing over the shoulders as far away from the neck as possible. The elbow should be bent at 90° but no more.
Make sure the sling fits correctly and doesn’t cause pain or discomfort. Normally your physiotherapist should let you position it yourself and then correct the position if necessary.
▶️How do you sleep with a greater tuberosity fracture?
Sleeping with a greater tuberosity fracture can be challenging, but several strategies can help increase comfort and promote healing
Wear the sling provided by the doctor for the first 6 weeks, including at night to minimise movement and pain as you sleep.
🟣Use pillows to raise your head and upper body, which can help reduce pressure on the injured shoulder.
🟣To manage pain and swelling at night, take pain medication as prescribed by your doctor especially during the first few weeks.
🟣Focus on getting enough rest to allow the fracture to heal and always wear comfortable clothes to avoid pressure on the injured area.
See also: Best sleeping positions for a broken humerus.
▶️What is the recovery time after a greater tuberosity fracture?
The question of recovery is normally the first question I always hear from patients I see in x-ray with greater tuberosity fractures.
What do we mean by recovery:
If it means regaining full use of the arm as before, then it can take several months or a complete year.
But it is a normal reaction to be worried, the truth is you will recover 100% or proportion close to 100% of your pre-injury capabilities.
I have seen people who engage in intensive athletic activities who have had greater tuberosity fracture, taking them a year and more to get back to a full use of the arm as before. But they do recover.
Resuming sports that put a lot of stress on the upper shoulder such as tennis, should be considered for at least 4 months
Fractures of the greater tuberosity that are non-displaced heal well and with in 4 t 6 weeks from the day of the fracture
Here are the average recovery times for people I have seen with greater tuberosity fractures.
| phase | Recovery timeline |
| Pain and swelling | A few weeks. |
| Wearing a sling | 6 weeks or more |
| Start gentle passive pendulum exercises | Immediately to avoid stiffness of the arm |
| Use your arm to cook, get dressed or shower without a sling | 2 months after the fracture or more in some people. |
| No longer needing a sling day and night | 6 to 10 weeks |
| Return to driving | 8 to 10 weeks. When you no longer use a sling, you can move comfortably with no pain, and you can control the vehicle safely. |
| Resuming sports | 4 months or more depending on the sport. |
| Un-displaced fractures | 6-12 weeks to heal |
| Severely Displaced fractures | Months to a year to regain full use of the arm |
| Resuming work | A few weeks after the fracture but this will depend on the type of job and recovery. |
Recovery times after a greater tuberosity fracture. Source: physiotherapist at my trust who deals with patients who have had these kinds of fractures. Limited medical data published in the international scientific literature.
What to take from this
🟣You are likely to regain 100% of your pre-injury capabilities
🟣You will be able to use your arm and shoulder than before the fracture
If you are worried about your recovery, please consult your medical team for advice.
We have come to the end of this article, wishing you a quick recovery!🙋
📚Sources:
Nóbrega Catelas D, Correia L, Adan E Silva F, Ribau A, Claro R, Barros LH. Greater tuberosity fractures of the humerus: complications and long-term outcomes after surgical treatment. Eur J Orthop Surg Traumatol. 2024 Jul;34(5):2541-2547. doi: 10.1007/s00590-024-03969-9. Epub 2024 Apr 30. PMID: 38684532; PMCID: PMC11291518.
Launonen AP, Sumrein BO, Reito A, Lepola V, Paloneva J, Jonsson KB, Wolf O, Ström P, Berg HE, Felländer-Tsai L, Jansson KÅ, Fell D, Mechlenburg I, Døssing K, Østergaard H, Märtson A, Laitinen MK, Mattila VM; as the NITEP group. Operative versus non-operative treatment for 2-part proximal humerus fracture: A multicenter randomized controlled trial. PLoS Med. 2019 Jul 18;16(7):e1002855. doi: 10.1371/journal.pmed.1002855. PMID: 31318863; PMCID: PMC6638737.
Shaw L, Hong CK, Kuan FC, Lin CL, Wang PH, Su WR. The incidence of occult and missed surgical neck fractures in patients with isolated greater tuberosity fracture of the proximal humerus. BMC Musculoskelet Disord. 2019 Oct 27;20(1):482. doi: 10.1186/s12891-019-2810-y. PMID: 31656189; PMCID: PMC6815442.
Image:J Orthop Sports Phys Ther 2010;40(7):447. doi:10.2519/jospt.2010.0411