Presentation
Recurrent anterior shoulder dislocation a few months ago
Patient Data
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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
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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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