When the damage only involves the labrum it is called a Bankart lesion. A Hill- Sachs lesion occurs when the lesion to the labrum presents simultaneously with a. There are two types of labral tears: SLAP tears and Bankart lesions. On MR a Hill-Sachs defect is seen at or above the level of the coracoid. Horst and his colleagues also found that a larger Hill-Sachs lesion leads to greater . Burkhart and de Beer first described the concept of engaging vs. . Bankart repair and remplissage for a large engaging Hill-Sachs lesion.
Cases and figures Imaging differential diagnosis. A Bankart lesion is an injury of the anterior inferior glenoid labrum of the shoulder due to anterior shoulder dislocation. Recent Findings The most recent literature covering the Hill-Sachs lesion has focused on the relatively new and unexplored topic of the importance of concomitant injuries while treating a humeral head defect.
Load and shift test to assess the adequacy of the glenoid by shifting the shoulder anteriorly. This creates a negative intra-articular pressure, which sucks the humeral head into the glenoid socket and prevents a downward translation of the humeral head. Oftentimes, it is sufficient to solely address the glenoid bone loss by increasing the articular arc to prevent engagement, or to repair the Bankart lesion to decrease the humeral head excursion.
Burkhart and de Beer first described the concept of engaging vs. Finally there is a medially displaced inferoanterior labrum at the o ‘clock position, i. Pain and a catching sensation with shoulder subluxation are also frequently described.
If the arm is pulled downward sulcus testthe humeral head may translate inferiorly in varying degrees. Arthroscopic Bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging Hill-Sachs lesion: A Clockwise approach to the labrum is the easiest way to diagnose labral tears and to differentiate lesoin from normal labral variants. Am J Sports Med. In German [ PubMed ].
There are benefits and drawbacks to each technique, and they must all be considered based on the size of the humeral head lesion and for each unique patient situation. Bankart tears may extend to superior, but this is uncommon. Excellent side-to-side symmetry in glenoid size and shape.
‘On-track’ and ‘off-track’ shoulder lesions
The lesion is associated with anterior shoulder dislocation. Frequently, authors consider that surgical treatment of recurrent shoulder dislocation is indicated when someone had more than five shoulder dislocations.
Shibayama and Iwaso found that an engaging Hill-Sachs lesion is highly susceptible to recurrence if treated hilp a typical arthroscopic capsuloligamentous repair with no attention to the osseous defect [ 6 ]. Due to the ABER-position the anterior band of the inferior GHL creates tension on the anteroinferior labrum and contrast fills the df.
This occurs when the round humeral head is forcibly impacted on the edge of the glenoid, which causes compression fractures in the humeral head. Notice the detatched labrum at the o’clock position on the sagittal MR-arthrogram.
Tear of meniscus Anterior cruciate ligament injury Unhappy triad Patellar dislocation Knee dislocation. The patient may display excessive translation of the humeral head within the glenoid joint. Humeral head bone defects: Notice the abnormal contour of the anterior glenoid and the avulsed anterior rim arrow. However, this procedure is uncommon given the variability in the derotation achieved and its reportedly high complication rate [ 76 ].
By contrast, studies have shown the value of ultrasonography in diagnosing Hill—Sachs lesions. The labrum of the shoulder joint can be torn as a consequence of a forceful shoulder dislocation.
The term for glenoid bone loss in conjunction with a Hill-Sachs lesion is bipolar bone loss, and it is a pathology that must not be overlooked sadhs 5 ].
Radiographic analysis of the Hill-Sachs lesion in anteroinferior shoulder instability after first-time dislocations. They relate to the mechanisms of injury and bone fracture characteristics and provide a guideline towards suitable treatments.
Bone augmentation of the humeral head has been shown to successfully u large Hill-Sachs lesions with or without concomitant glenoid bone loss Fig. This technique consists of transecting the proximal humerus transversely at the surgical neck and retroverting the humeral head with relative to the humeral shaft, with the objective being to theoretically achieve derotation of the humeral head, thus preventing re-engagement of the lesion.
All that is needed is a ruler. This results in instability and recurrent dislocations. Kumar VP, Balasubramaniam P.
Hill Sachs Lesion
The ABER-view shows an absent antero-inferior labrum. The remplissage technique is utilized in patients with engaging Hill-Sachs lesions in conjunction with mild glenoid bone loss, and it is most often used concurrently with an arthroscopic or open Bankart repair Fig.
Fox, Anthony Sanchez, and Tyler J. The images in ABER-position demonstrate a detached anterior labrum. The disadvantages of this technique are the technical difficulty of bahkart procedure, graft reabsorption, graft failure, and cyst formation.
A medical history sets the beginning of a clinical investigation to evaluate the possible causes, injuries and previous shoulder dislocations that have lead to a recurrent shoulder dislocation.
Partial resurfacing of the humeral head impression fracture with a cobalt-chrome articular component is a relatively new technique that offers advantages in comparison to other osseous defect repair procedures [ 68 ].
Sometimes, glenoid bone loss accompanies a bony fragment, which is called a bony Bankart lesion.