Prior anterior glenohumeral joint dislocation with Hill-Sachs fracture and Perthes lesion
Imaging Findings:
• The arrow is displaying hyperintense signal of the anteroinferior glenoid labrum tear. There is also stripping of the glenoid periosteum and uplifting of the anterior labrum from the glenoid (solid arrows) without detachment. This is a Perthes lesion.
• These ovals are outlining the impaction fracture of the superolateral humeral head.
• Measure the depth of the Hill-Sachs impaction fracture on Coronal (>4mm).
- Also measure approximate % of humeral head involved using the linear method (A/B).
Case description:
• Anterior glenohumeral joint dislocations often present with a combined anteroinferior glenoid pathology and humeral head posterolateral Hill Sachs impaction fracture.
• Anterior labroligamentous tear with periosteal stripping → Perthes lesion.
- Difficult to see on arthroscopy due to granulation tissue and no labral displacement.
• Hill-Sachs impaction fracture in 80% of anterior GH dislocations. Measure the depth (or % of humeral head) of the deformity:
>4mm depth is more prone to engagement/recurrence → surgical repair.
>25% of humeral head → likely surgical repair
Differential diagnosis:
• Bankart lesion: Anteroinferior labral tear and inferior glenohumeral ligament detached. No periosteal stripping or displacement and NO osseous component.
• Bony Bankart: Osseous defect of the anterior glenoid rim with an associated anteroinferior labroligamentous tear.
• ALPSA: Anterior Labrum Periosteal Sleeve Avulsion. Similar injury to the anterior glenoid labrum with anterior glenoid periosteal stripping. However the labrum displaces medially → CHRONIC INSTABILITY
• GLAD lesion: Glenoid Labrum Articular Disruption: superficial anteroinferior labral tear with an adjacent focal chondral defect of the glenoid.
Dr. Donald von Borstel @DrvonBorstel
#HillSachs #fracture #Perthes #lesion #clinical #mri #clinical #Radiology #diagnosis #msk
