Presentation
The patient woke up from sleep with severe shoulder pain bilaterally.
Patient Data
MRI of the shoulder joints demonstrates cortical disruption and displaced avulsion fractures of the right and left greater tuberosities. Associated findings include bone marrow edema, hemarthrosis, and diffuse edema of the supraspinatus tendons. Notably, no complete tendinous tears were identified.
Case Discussion
Bilateral avulsion fractures of the greater tuberosity are a rare but serious injury that can occur after a seizure. During a seizure, the violent muscle contractions, particularly of the supraspinatus and infraspinatus muscles, can avulse (tear away) a fragment of bone from the greater tuberosity.
In this case, the patient, a known case of epilepsy, woke up from sleep with severe shoulder pain and denied any history of trauma.
Acknowledgment: Nusaibah Ghaleb Yousef Alnahari
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