Hill-Sachs lesion with bony Bankart lesion

Case contributed by Dr Mahmoud Yacout Alabd

Presentation

Right shoulder pain with history of recurrent dislocation.

Patient Data

Age: 25 years
Gender: Male

A linear bony fragment (chipped fracture) related to the inferior aspect of the glenoid process raises the possibility of a bony Bankart lesion, otherwise everything else seems to be in order. 

The CT confirms the X-ray finding of a chipped fracture of the inferior aspect of the glenoid process, however a wedge shaped defect can also be seen at the posterior aspect of the humeral head, that was not evident on the plain radiograph suggesting Hill-Sachs lesion with bony Bankart.

Evident of a tear of the anterior inferior aspect of the glenoid labrum (linear bright signal/defect) with an osseous component (linear hypointensity). 
Another defect noted at the posterior aspect of the humeral head.

MRI confirms the findings seen on X-ray and CT of Hill-Sachs lesion with bony Bankart as sequelae to recurrent shoulder dislocation. 

Case Discussion

Hill-Sachs fracture and Bankart lesion are common sequelae to recurrent anterior dislocation of the shoulder joint. Hill-Sachs lesion is a compression fracture of the posterolateral humeral head due to its compression against the anteroinferior part of the glenoid when the humerus is anteriorly dislocated.  A Bankart lesion results from a detachment of the anterior inferior labrum from the underlying glenoid due to the same mechanism. It may occur as an isolated injury to the labrum, or it can extend to the bony glenoid margin, where it is called a "bony Bankart". In most cases, both findings are associated together.

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