CASE REVIEW HILLSACHS LESION ( IMPACTION FRACTURE )

29 yr old male patient with H/o Recurrent anterior

dislocation of the Rt shoulder.

MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARH

MERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH

HISTORY………………………….

• Harold Arthur Hill and Maurice D. Sachs were 20th-century American Radiologists who described the association between an anterior dislocation of the glenohumeral joint and a compression fracture of the posterolateral aspect of the humeral head.

Definition …….Etiology………….

• A Hill-Sachs lesion, also Hill-Sachs fracture, is a cortical depression in the posterior superior head of the humerus bone. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.

• The average depth of Hill-Sachs lesion has been reported as 4.1 mm.

• The lesion is associated exclusively with anterior shoulder dislocations – Sports– Falls, seizures– Assaults, throwing, – Reaching, pulling on the

arm, or even just turning over in bed can all be causes of anterior dislocations.

IMAGING OPTIONS• AP Radiographs of the shoulder with

the arm in internal rotation offers the best yield while axillary views and AP radiographs with external rotation tend to obscure the defect.

• The Stryker-Notch view, is often used specifically to look for a Hill-Sachs lesion.

• The sensitivity and specificity of 1. Radiography is 65% and 67%,

respectively. 2. Ultrasonography has sensitivity of

96% and specificity of 100%3. MRI has been shown to be 97%

sensitive and 91% specific at detecting the fractures.

Present case ……………………

• 29 Yr old male with h/o Recurrent anterior dislocations of the Rt shoulder .

• MR Rt shoulder done .• First two axial cuts dedicatedly

assessed .• Exaggerated Concavity of the

posterolateral aspect of the Rt humeral head is appreciated along the anteroposterior extent of the 19.5mm . Thin curvilinear streak of edema is appreciated in this region. This observation is appreciated in the first two axial cuts of the Rt humeral head and is supportive of hill sachs lesion .

FIRST AXIAL CUTSUPRASPINATUS

MUSCLE TIW , T2W SEQUENCE

SECOND AXIAL CUTFOCAL DEPRESSION /

IMPACTION FRACTURE ALONG THE

SUPEROLATERAL ASPECT OF THE RT HUMERAL HEAD

FOCAL EDEMA

FAT SATURATION SEQUENCE APPRECIATE FOCAL EDEMA AT IMPACTION

FRCATURE SITE

CORONAL PLANE

SAGITTAL VIEW

HOLISTIC LOOK …… MULTIPLANAR VIEWS

CORONAL VIEW AXIAL VIEW

A suggested approach towards hill sachs lesion/fracture …………….

• History ( Anterior shoulder dislocation) .• Conventional Radiography – AP radiograph with internal

rotation• Special views – Stryker notch view is of help.• MR – Multiplanar imaging

• First two axial cuts important.• Depth of the hill sachs defect can be ascertained.• Ancillary findings – Glenohumeral labroligamentous

complex and rotator cuff assessment done.