Hill-Sachs and Bankart Lesions

Introduction

A Hill-Sachs lesion usually results from an anterior shoulder dislocation with resultant posterolateral humeral head compression fracture as the humeral head comes to rest against the anteroinferior part of the glenoid. It is often associated with a Bankart lesion of the glenoid.

Hill-Sachs Lesion

• A Hill-Sachs lesion occurs in more than 50 percent of patients with a primary dislocation.
• This lesion is associated with an increased risk of recurrent dislocation
  

Radiographic Appearance

Hill-Sachs Lesion

This 21 year old male injured his right shoulder playing team sports. The contours of the humeral head are normal	A subsequent sporting injury to his right shoulder resulted in an anterior subcoracoid dislocation of the glenohumeral joint. The post-reduction AP shoulder projection image is shown above. Note the Hill-Sachs lesion (arrowed)- compare with the patient's previous shoulder radiography (left)

Reverse Hill Sachs Lesion

The reverse Hill-Sachs lesion is associated with a posterior shoulder dislocation rather than the more common anterior dislocation	The reverse Hill-Sachs lesion (arrowed) is associated with a posterior shoulder dislocation rather than the more common anterior dislocation

Case Studies

Case 1

	These are the post-reduction images on a patient who suffered a dislocated shoulder. The arrowed structure is likely to be a Bankart lesion.
	The gleno-humeral joint view image similarly displays the Bankart lesion
	Bankart and Hill-sachs lesions can occur together- the same mechanism (shoulder dislocation) results in both lesions. The arrowed structure is a Hill-sachs lesion. This is an impaction fracture where the articular surface of the humerus was forcibly impacted on the gleniod when the shoulder was dislocated.

Case 2

	This patient has gad a surgical repair of a Bankart lesion

Case 3

This patient presented to the ED following an epilectic fit. The patient suffered dislocations of both shoulders. The SI view of the right shoulder (post-reduction) demonstrates a large Hill-sachs lesion (arrowed).	The SI view of the left shoulder appears normal.

Case 4

	This patient was involved in a motor vehicle accident. The AP view of the shoulder reveals an antero-inferior dislocation of the left glenohumeral joint
	The lateral shoulder view demonstrates the humeral head to be located anterior to the gleniod. The arrowed structure is a Hill-sachs lesion of the supero-posterior aspect of the humeral head
	CT scanning confirmed a large Hill-sachs lesion

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