The Case
After successfully reducing the shoulder of a young athlete – his fourth, your first. He says the the last 2 times he dislocated it was reduced by his team trainer on the sidelines. You obtain XRays and note the following.
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The Diagnosis
This is a Bankart lesion. Note the abnormality in the inferior third of the glenoid labrum (in the annotated XRay). With repeated anterior-inferior shoulder dislocations a groove or pocket forms in the front of the glenoid. XRays have sensitivity/specificity in the 60%s with MRI being 96% sensitive and 100% specific according to Cicak et al, J Ultrasound Med, 1998.
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It is often accompanied by a Hill Sachs lesion, which is a concave cortical depression on the humeral head. The latter is also seen in patients with multiple dislocations, and occurs when the humeral head forcefully impacts against the anteroinferior glenoid rim (seen below).
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Management
Both of these findings in isolation (or together), and especially in the context of multiple dislocations are basically a signal to send the patient to Ortho. The management of a Hill-Sachs lesion is repair when there is shoulder instability. Bankart lesions are also best managed by a surgeon.
