Figure 1
Hill Sachs lesion (black arrow) seen as a cortical depression of the postero-superior aspect of the humeral head. This depression is located medial to the head-neck junction (arrowhead). A Bankart lesion (fracture of the antero-inferior aspect of the glenoid rim) is also seen (white arrow).
Figure 2
Bilateral frontal shoulder radiographs obtained with varying degrees of rotation of the humeral head, from neutral (a) to internal rotation (c), without any modification to the beam angulation. The Hill-Sachs lesion (arrow), is not visible in neutral rotation. The pathological nature of the cortical irregularity of the postero-superior aspect of the humeral head can be affirmed in view of the normal aspect of contralateral asymptomatic left side.
Table 1
Impaction fractures on humeral and glenoid sides related to antero-inferior shoulder dislocation.
| Hill-Sachs Lesion | Bony Bankart lesion | |
|---|---|---|
| Bone | Humerus | Glenoid |
| Location | Postero-superior | Antero-inferior |
| Detection at radiography | Relatively easy | Difficult |
| Radiographic view | Garth view | Garth view |
| Diagnostic value | +++ | +++ |
| Prognostic value | + | +++ |
| Value of CT/MRI | + (Quantification of bone loss, “engaging” or “off-track” lesions [21, 27] | +++ (Quantification of bone loss) |
Figure 3
Varying visibility of the of the Hill-Sachs lesion depending on the angulation of the X-ray beam. Surface rendering reformats of the shoulder simulating varying degrees of angulation of the X-ray beam (as seen by the varying aspect of the acromion). With an ascending beam (a), the Hill-Sachs lesion is almost not visible. With a descending beam (b), the lesion is obvious.
Figure 4
Frontal view of the shoulder in neutral rotation (a) and abduction/internal rotation (b) The depression (arrow) on the posterior head-neck junction of the humerus is a normal finding. The CT arthrogram axial image going through the mid third of the glenoid (c) shows the cortical depression with a large diameter base (arrow). The adjacent trabecular bone has a normal appearance. A CT arthrogram axial image through a more cranial part of the humeral head and the coracoid process (d) shows a depression with a smaller diameter base (arrowhead), corresponding to a Hill-Sachs lesion with sclerosis of the adjacent trabecular bone.
Figure 5
Variant of Hill-Sachs lesion in the form of a bony protuberance (arrow) rather than a depression, corresponding to its elevated margin, to which the beam is tangent.
Figure 6
Variant of Hill-Sachs lesion on the frontal view in neutral rotation (a), in the form of an “osteophyte-like” protuberance, in relation to the large depressed Hill-Sachs lesion visible with a descending beam (b).
Figure 7
Interindividual variability of normal bony contours at the head-neck junction of the humeral head at radiography (a and c) and ultrasound (b and d). Marked depression (arrows in a, b) vs. smooth shallow depression (arrowheads in c, d).
Figure 8
Bony Bankart lesion. Frontal view of the shoulder (a) showing irregularity of inferior glenoid rim (arrow) and loss of visualization of subchondral bone at most inferior aspect of glenoid. Frontal view in abduction, internal rotation of the shoulder (b) showing double contour of inferior margin of glenoid (arrowheads).
Figure 9
Bilateral frontal views of the shoulder showing protruberance at postero-superior aspect of humeral head on left side (arrowhead) that may correspond to Hill-Sachs lesion. Bilateral Bernageau views (c, d) showing normal glenoid margin on right side (arrow in c) and osseous substance loss with blunting of the antero-inferior margin of glenoid on left side (arrow in d), corresponding to a Bankart lesion.
Figure 10
Hill-Sachs and Bankart fractures on Garth view. (a) Frontal shoulder radiograph (a) showing no abnormality. Garth view (b) showing a postero-superior depression of humeral head (arrowhead) and fracture of antero-inferior margin of glenoid (arrow).
Figure 11
Radiographic (a) and CT (b) of bony Bankart lesion. Displaced bony fragment (arrow in a) and loss of subchondral bone plate (arrowheads). Radiographic (c) and CT (d) of fracture of lesser tubercle (arrows in c and d) mimicking a bony Bankart lesion at radiography (c).
Figure 12
Frontal radiograph of shoulder showing double contour of humeral head (“trough sign”) (arrow) due to an reverse Hill-Sachs lesion secondary to history of posterior dislocation.
Figure 13
Patient with history of posterior shoulder dislocation. Radiograph (a) showing abnormal line on the humeral head (arrow). At CT, the deformity of the humeral head corresponds to the shape of the posterior margin of the glenoid.
Figure 14
Radiograph showing ossification (arrow) at the insertion side of inferior glenohumeral ligament appeared after antero-inferior dislocation of the shoulder.