MyPACS.net: Radiology Teaching Files > Case 5345277

never visited HILL-SACHS LESION
Contributed by: Radiology Residency Program Faculty & Staff.
Patient: 71 year old female
History: 71 y/o female with traumatic shoulder dislocation (reduced at outside hospital) from MVA with car rollover.
Images:[small]larger

Fig. 1: Scout image demonstrates the impaction fracture of the posterosuperior humeral head.

Fig. 2: Multiplanar CT images demonstrate an impaction fracture of the posterosuperior humeral head.

Fig. 3: Multiplanar CT images demonstrate an impaction fracture of the posterosuperior humeral head.

Fig. 4: Axial image of the shoudler inferior to the fracture site reveals no abnormality

Fig. 5: Multiplanar CT images demonstrate an impaction fracture of the posterosuperior humeral head.

Fig. 6: Multiplanar CT images demonstrate an impaction fracture of the posterosuperior humeral head.

Fig. 7: Multiplanar CT images demonstrate an impaction fracture of the posterosuperior humeral head.

Fig. 8: Multiplanar CT images demonstrate an impaction fracture of the posterosuperior humeral head.

Fig. 9: Multiplanar CT images demonstrate an impaction fracture of the posterosuperior humeral head.
Findings:

Scout and multiplanar CT images demonstrate an impaction type fracture of the posterior and superior humeral head consistent with a Hill-Sachs Fx.

Diagnosis: Hill-Sachs Lesion
Discussion:

A Hill-Sachs lesion is defined as an impression or impaction fracture of the posterosuperior humeral head which is caused by trauma against the inferior glenoid rim.

It is actually one of many osteochondral injuries that can occur due to repeated stress or direct trauma from dislocation. 

Hill-Sachs lesion is seen in 27% of acute anterior glenohumeral dislocations and in 74% of recurrent dislocations.

It is visualized in only 50% of AP radiographs.

CT can be helpful in indentifying free fragments and MRI can be helpful in identifying associated injuries. 

The lesion is sometimes confused with the normal bare area of the postero-inferior aspect of the humeral head. The Hill-Sachs lesion causes a defect through the cartilage and cortical bone and there should be reactive marrow edema on MRI.

Hill Sachs lesion may destabilize the glenohumeral joint predispose to further dislocation.


The Hill-Sachs lesion is considered a pathognomonic sign of shoulder instability that can be demonstrated with appropriate imaging. Arthroscopy may pick up subtle Hill Sachs lesions that aremissed on imaging.


References:

1. Koval, K. Zuckerman, J. Handbook of Fractures. 2nd Edition. Lippincott; Philadelphia, 2002.
2. Stoller, S. Tirman, P. Bredella, M. Beltran, S. Branstetter, R. Blease, S. Diagnostic Imaging: Orthopedics. Amirsys: Salt lake City, UT, 2004.

 

Submitted by Craig Johnson, DO PGY-4 Radiology Resident and William Wallace, MD Attending Physician Aultman Hospital

Comments:
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Additional Details:

Case Number: 5345277Last Updated: 07-18-2006
Anatomy: Skeletal System   Pathology: Trauma
Modality: CT, Conventional RadiographExam Date: Access Level: Readable by all users
Keywords: hill-sachs lesion, ocsteochondral injury, humeral head

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