Posterior shoulder dislocation with reverse Hill-Sachs and reverse bony Bankart injuries

Case contributed by Bálint Botz
Diagnosis certain

Presentation

Sustained a fall while jogging.

Patient Data

Age: 60 years
Gender: Male
  • The humeral head is fixed in an internally rotated position (light bulb sign) indicating posterior dislocation, however there is no complete loss of overlap between the glenoid fossa and the humeral head.
  • Two-parallel running, ill-defined sclerotic bands (trough line sign) are visible in the anterior aspect of the humeral head, suggestive of impression fracture
  • Small avulsed fragment inferiorly, suggestive of bony injury of the glenoid. 
  • Moderate degenerative changes particularly in the AC joint, soft tissue calcifications adjacent to the insertion of the supraspinatus tendon, indicating tendinopathy. 

CT confirms impacted reverse Hill-Sachs fracture secondary to the posterior dislocation, as well as inferior reverse bony Bankart injury of the glenoid. 

Case Discussion

Both the reverse Hill-Sachs lesion and reverse bony Bankart injury are commonly associated with posterior shoulder dislocations. 

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