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Off track Hills Sachs defect

Case contributed by Mohamed Saber
Diagnosis almost certain

Presentation

Recurrent anterior shoulder dislocation a few months ago

Patient Data

Age: 30 years
Gender: Male
mri

The glenoid labrum is detached anteroinferior with associated fracture of the anterior glenoid rim consistent with a bony Bankart lesion

Localized cortical depression involving the posterolateral aspect of the humeral head consistent with a Hill Sachs defect

Moderate glenohumeral joint effusion with an intra-articular loose body at the axillary recess likely a displaced detached labrum/ bony glenoid

Mild fluid in the subscapularis recess and mild effusion of the distal biceps tendon sheath inside the bicipital groove

Mild acromioclavicular joint osteoarthritis and supraspinatus tendinopathy
 

Annotated image

The glenoid track = (0.83 x D) - d. In this case, It measures about 17 mm

Hill-Sachs interval measures 23 mm.

Case Discussion

Here is a case of recurrent anterior shoulder dislocation on top of a combined bony Bankart lesion and Hill Sachs defect known as bipolar shoulder lesions.

non-engaging, on-track Hills-Sachs defect: Hill-Sachs interval < glenoid track

engaging, off-track Hills-Sachs defect: Hill-Sachs interval > glenoid track

In this case, there is no significant boney bridge between the rotator cuff attachment and lateral aspect of the Hill-Sachs defect in the axial plane and therefore the Hill-Sachs interval approximately corresponds to the size of the Hills-Sachs defect.

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