Off-track bipolar shoulder lesions

Case contributed by Dr Henry Knipe

Presentation

Episode of shoulder instability.

Patient Data

Age: 30 years
Gender: Male

Long head biceps tendon is intact. Small biceps tendon sheath effusion. Subscapularis, supraspinatus, infraspinatus and teres minor tendons are intact. No subacromial bursal effusion. Rotator cuff muscle belly bulk and signal are preserved.

Intact acromioclavicular joint. Type II acromion. No os acromiale.

Normal glenohumeral alignment. Small glenohumeral joint effusion. Rounded anteroinferior glenoid with low signal sclerotic edges. Glenoid labrum is detached antero-inferiorly with periosteal stripping diffuse rounded high signal and scarred; adjacent soft tissue edema. Superior chondrolabral high signal is suspicious for a SLAP lesion. Chronic appearing Hill-Sachs defect. Glenoid track measures 18 mm. Hill-Sachs interval measures 23 mm. Inferior glenohumeral ligament is intact. No evidence of adhesive capsulitis.

No aggressive focal osseous lesion. 

Sagittal T1: Glenoid track measures 18 mm.

Axial PDFS: Hill-Sachs defect measures 23 mm.

Case Discussion

Prior anterior glenohumeral instability has resulted in anteroinferior glenoid bone loss, chronic appearing Bankart lesion and Hill-Sachs defect, possible SLAP tear and a potentially engaging off-track bipolar lesion. 

The lack of edema makes this a chronic injury and the "ground away" appearance of the anteroinferior glenoid with sclerotic edges indicates that there have been multiple episodes of instability. 

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