Hill-Sachs lesion and labral injury (ultrasound)

Case contributed by Brendan Cullinane
Diagnosis certain


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

Patient Data

Age: 45 years
Gender: Female

Small cortical deficit beneath the infraspinatus raising the possibility of a Hill-Sachs lesion and anterior dislocation.

The posterior joint is widened and there is hemarthrosis. The no effusion at the superior joint and the superior labrum is visualized. No effusion at the anterior joint and the labrum is visualized.

Asymmetric thickening of the coracohumeral ligament. The CH ligament is slightly thickened adjacent to its coracoid attachment at 3.6 mm. Further from the coracoid, the ligament returns to normal caliber. No surrounding hyperemia was evident. The thickness is less than the 4.1mm associated with adhesive capsulitis on MRI. The patient was not clinically assessed for adhesive capsulitis due to her possible dislocation and fracture.

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 hemarthrosis. 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 orthopedic 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 hyperemia. 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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