Background Arthroscopy is nowadays a well-establish method to treat a wide range of injuries and overuse syndromes of the shoulder. The role of arthroscopy is extremely important for the treatment of soft-tissue injuries and specific-type fractures of the shoulder.

Aim to estimate the applicability of shoulder arthroscopy as an effective method for the treatment of fractures of the greater tuberosity in athletes.

Patients–Methods Twelve athletes (six professional–six recreational, four skiers–two horse riders–two motorcycle racers–one cyclist–one football player–one hardle jumper–one judoka, eight males-four females) with a mean age of 29 (20–45) years, sustaining an avulsion fracture of the greater humeral tuberosity were treated arthroscopically over a 5-year period. Nine were managed acutely and three as malunion and rotator cuff dysfunction cases. For the imaging evaluation, standard plain radiographs (anteroposterior and axillary views), CT scans (with 3D reconstruction) and MRI were performed. In three patients the fragment dislocation was found ≤5 mm, in four was 6–10 mm and in two was more than 10 mm. Anchors were used to fix the avulsed fragment. In nine patients, accompanying soft-tissue lesions (seven rotator cuff tears and two Bankart lesions) were recognized and properly treated. Postoperatively a shoulder abduction brace 30° was applied for six weeks and a careful rehabilitation plan was utilized. Passive external rotation exercises were started immediately.

Results During the follow up period no major complication was observed. Radiographic outcome was assessed on plain X-rays. No patient developed non-union. All patients achieved UCLA scores over 30 at six months. Professionals returned to practicing at 10–12 weeks with customized programs. All athletes returned to their pre-operative activity level with no residual pain.

Discussion The investigation of indications of shoulder arthroscopy is a continuous process. Surgical familiarity is important to perform advanced techniques in shoulder arthroscopy. Arthroscopic treatment of minimally displaced greater tuberosity fractures should be considered for athletes or people who perform overhead activities.

Conclusions Arthroscopic treatment of fractures of the greater humeral tuberosity can offer excellent functional results and permits the treatment of concomitant critical lesions.