Subscapularis Avulsion of the Lesser Tuberosity in Adolescents
Bibliographic record
Abstract
BACKGROUND: Lesser tuberosity avulsion fractures in adolescents occur infrequently. Perhaps because of their rarity, many cases are missed on initial physical exam, imaging studies, and even diagnostic arthroscopy, leading to delay in diagnosis. Without operative intervention, these injuries may cause significant morbidity, whereas operative fixation has predictably good results. We review 6 cases and compare them to a review of the previous published cases. METHODS: All cases of isolated lesser tuberosity avulsions in skeletally immature patients treated by the senior author (MTB) at a pediatric referral center were included. The mean follow-up was over 4 years (range, 2 to 7 y). Operative treatment consisted of a diagnostic arthroscopy to evaluate for concomitant pathology, followed by an open reattachment of the tuberosity through an incision in line with the anterior axillary fold. A lasso technique using suture anchors and sutures to loop over and hold down the fragment is our preferred method as it decreases the risk of fracture seen with fixation using screws or sutures through drill holes in the tuberosity. RESULTS: Even with a frequent delay in diagnosis, all patients had a predictably good outcome with an average American Shoulder and Elbow Surgeons score of 97 (range, 88 to 100) and a Western Ontario Shoulder Instability Index of 94 (range, 84 to 100). The patient history, symptoms, and physical exam findings were consistent across the published cases. The prototypical patient is a male, age 13, who sustains an abduction and extension injury during sports. Anterior shoulder pain, positive belly press, and lift-off signs are frequent findings. CONCLUSIONS: A high index of suspicion is needed to recognize this uncommon injury. History, physical exam for subscapularis function, and magnetic resonance imaging should be diagnostic. Operative treatment with a suture anchor lasso technique leads to predictably good results. LEVEL OF EVIDENCE: Level IV therapeutic study.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".