IS Case 272: Bankart lesion and Hill-Sachs deformity
Imaging Sciences URMC 2009
Publication Date: 2009-07-29
History
Patient is a 51-year-old male with shoulder pain.
Findings
Low-lying humerus is suspicious for joint laxity or instability. There is a cortical irregularity of the posterolateral humerus, a severe inferior glenoid deformity and an area of cortical discontinuity.
Diagnosis
Bankart lesion and Hill-Sachs deformity
Discussion
The Bankart lesion and Hill-Sachs deformity are associated with anterior dislocations of the shoulder. They occur with an extension, abduction, external rotation injury such as during a direct blow to the shoulder or traction on a limb.
The Bankart lesion is a glenoid labrum fracture. This should be suspected on the axillary view of the shoulder which shows injury to the glenoid rim (the so called bony Bankart injury). The Bankart injury is indicative of detachment of the inferior glenohumeral ligament (a major stabilizer of the shoulder joint) and labrum from the anterior glenoid process.
The Hill-Sachs deformity is an impaction fracture of the posterolateral humeral head at or above the level of the coracoid process. It occurs in 50% of anterior shoulder dislocations and is best seen on the AP internal rotation of the shoulder. These lesions occur from impaction of the posterolateral humerus against the anterior edge of the glenoid rim during an anterior shoulder dislocation.
The presence of both a Bankart lesion and a Hill-Sachs deformity is pretty conclusive of a prior shoulder dislocation. A low-lying humerus, such as that seen in this case, is suspicious for joint laxity or instability.
Treatment is immediate reduction. Multiple dislocations may require surgical treatment.
References
- Brant WE, Helms CA, eds. Fundamentals of Diagnostic Radiology, 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2006.
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