Comminuted Bankart Lesion and Shoulder Instability: CT Case Review

She is found to have a swollen painful left shoulder with reduced range of motion in all directions. Her left arm is neurovascularly intact.

An X-ray of the shoulder found an enlocated shoulder with an irregularity around the glenoid rim. Shoulder dislocations may be complicated by Hill-Sachs or Bankart lesions.

These often occur during shoulder dislocations when the humeral head is forcibly impacted on the glenoid rim. These injuries can contribute to future shoulder instability, and their management is determined by the size of the injury and associated instability of the shoulder joint.

Hill-Sachs defects are cortical depressions of the posterolateral aspect of the humeral head. They occur in up to 40% of anterior shoulder joint dislocations (1) and are best seen on AP X-rays with the arm held in internal rotation.

These injuries may be managed nonoperatively if the bony defect is small (<20% of the articular surface of the humeral head) and the glenohumeral joint remains stable during desired activities (3). Surgical management involves bone grafting or placement of soft tissue within the defect.(3).