Hill-Sachs lesion and labral injury on ultrasound

Case contributed by Brendan Cullinane

Presentation

Fallen and landed on her left shoulder while running down a hill. The patient's arm was immobilised.

Patient Data

Age: 46 years
Gender: Female

See individual images for description. 

The suspected fracture of the posterior humeral head seen on ultrasound is confirmed with CT (David Sloane radiographer, Dr. Gary Geier radiologist).

Case Discussion

Ultrasound of the left shoulder revealed intact and unremarkable anterior labrum and superior labrum. The posterior labrum appears completely ruptured with a widened joint space and haemarthrosis. There was a small Hill-Sachs lesion beneath the infraspinatus tendon. These findings point to anterior dislocation of the glenohumeral joint.

There was a step-off deformity beneath the teres minor tendon raising the suspicion of a fracture. Closer examination of the x-ray showed the fracture in one view of an orthopaedic series. An undisplaced fracture was diagnosed by CT.

The coracoid end of the coracohumeral ligament was slightly thickened but not to a degree strongly associated with adhesive capsulitis. There was no surrounding hyperaemia. In light of the anterior dislocation and likely fracture, clinical testing for adhesive capsulitis was not performed.

There was hemorrhage within the cul-de-sac, contusion and likely minor tearing of the supraspinatus (not shown).

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Case information

rID: 12884
Case created: 27th Jan 2011
Last edited: 1st Jun 2016
Inclusion in quiz mode: Included

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