Review Question - QID 877

The MRI shows an anterior labral detachment (illustration A) and a Hill-Sachs defect (illustration B). Hill-Sachs defects occur in shoulder instability when an anteriorly dislocated humeral head contacts the glenoid. This leaves an impression on the postero-superior aspect of the humeral head. The most common pathologic finding in shoulder instability is the Bankart lesion, which is a tear of the anterior inferior labrum/anterior band of the IGHL (inferior glenohumeral ligament).

Hintermann et al showed that 87% of the shoulders they scoped after dislocation had labral tears at the anterior and anteroinferior margin of the glenoid; 68% had a Hill Sachs lesion.

In a study by Taylor et al, 63 of 67 (97%) had Bankart lesions, but none had rotator cuff tears. Hintermann’s study of 212 pts showed 30 (14%) rotator cuff tears.

Incorrect Answers:
1-Rotator cuff tears following anterior shoulder instability are much more common in older patients (>50 years old), but rare in the young patient.
2-SLAP tears are commonly seen in athletes with repetitive overhead activity (e.g. pitchers, volleyball players).
4-Glenoid fractures (e.g. Bony Bankart) can occur in shoulder instability, but these are much less common than Bankart lesions.
5-Humeral avulsion of glenohumeral ligaments (HAGL) can occur from shoulder instability, but is much less common than the Bankart lesion (only 1 of 67 in Taylor's study had a HAGL lesion).