First of all, it applied to those patients with a single, or first time, dislocation. Preoperative analysis of the hillsachs lesion in anterior. Lesiones tipo bankart y hillsachs tras luxacion anterior del hombro. Relationship with bankart lesion on arthroscopy and frequency of shoulder dislocations article pdf available january 20 with 14 reads. A bankart lesion is an injury of the anterior glenoid labrum of the shoulder due to anterior shoulder dislocation. The first anatomic description of the traumatic notch on the humeral head was made in 1855 by malgaigne. The relationship between hillsachs lesion and recurrent. A bankart lesion1 is a lesion of the anterior part of the glenoid labrum of the shoulder. Magnetic resonance imaging mri has been shown to be sensitive in detecting these two lesions. The size of a hillsachs lesion determines the cooccurrence of cartilaginous or bony bankart lesions. A hill sachs lesion occurs when the lesion to the labrum presents simultaneously with a. A hillsachs lesion, or hillsachs impaction fracture, is an injury to the back portion of the rounded top of your upper arm bone humerus. Humeral avulsion of glenohumeral ligament lesions this lesion very difficult to visualize arthroscopically.
Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic bankart repairs. It can also bring damage to the connection between the labrum and capsule. The aim of this study is to investigate the correlation between bankart lesions and hillsachs lesions on mri for. Hillsachs lesions are a posterolateral humeral head compression fracture, typically secondary to recurrent anterior shoulder dislocations, as the humeral head comes to rest against the anteroinferior part of the glenoid. In treatment of a bankart or a hillsachs lesion, it is important to consider the cooccurring injury. Horst and his colleagues also found that a larger hill sachs lesion leads to greater. The presence of bankart or hillsachs lesions on mri for the primary shoulder dislocation group was similar to the recurrent group 73% vs.
Hill sachs lesion on mr arthrography of the shoulder. Arthroscopic treatment of a reverse hillsachs lesion. There is a strong correlation between both lesions. On mr a hill sachs defect is seen at or above the level of the coracoid. Patients were excluded if there was no hill sachs lesion identified on mri. The hill sachs lesion is a compression fracture of the posterosuperolateral aspect of the humeral head that occurs when it comes into contact with the dense cortical bone of the anterior glenoid. A hillsachs lesion is a fracture in the long bone in the upper arm humerus that connects to the body at the shoulder.
A hillsachs lesion is a serious injury of the shoulder. A bankart tear is a specific injury to a part of the shoulder joint called the labrum. The mri technique is sensitive in diagnosing both injuries. Avoid placing the joint capsule under stress by stretching into abduction or er during the early phases of rehabilitation, until dynamic joint stability is restored. Hill sachs lesion bankart lesion medical billing and. Hillsachs lesion orthopaedicsone images orthopaedicsone. An mri may also be obtained in patients who have dislocated their shoulder. Outcomes of arthroscopic hillsachs remplissage and anterior bankart repair. Avoid activities in extreme roms early in the rehabilitation process. While the shoulder has an extensive range of motion, it is also easy to dislocate. The hillsachs lesion is an osseous defect of the humeral head that is typically associated with anterior shoulder instability.
An engaging hillsachs lesion is one that predisposes or. First, the prevalence of hillsachs lesions was compared with the arthroscopic findings. The purpose of this study was to compare the clinical results of isolated arthroscopic bankart repair and those of arthroscopic bankart repair with posterior capsulodesis for anterior shoulder instability with engaging hillsachs lesions. Reverse hillsachs lesion has been described in patients with posterior shoulder instability. In order to understand this, you need to understand the anatomy of the shoulder joint. The prevalence and size of hillsachs lesions were evaluated preoperatively by ct in 142 shoulders 30 with primary instability and 112 with recurrent instability before arthroscopic bankart repair. There is subjacent bone marrow edema at the posterolateral humeral head which defines the hill sachs lesion. Bankart lesion or hillsachs lesion on mri for those with the primary shoulder dislocation is almost similar to the one for the recurrent group 73% vs. This study was undertaken to assess the diagnostic validity of computed tomography ct with 3dimensional 3d. Assessment of coincidence and defect sizes in bankart and. Thirtyfive shoulders that underwent isolated arthroscopic bankart repair bankart group and 37 shoulders that underwent arthroscopic bankart repair with.
It is an indication for surgery and often accompanied by a hillsachs lesion, damage to the posterior humeral head. Bankart tears do not always show up well on mri scans. Better suited to open approach engaging hillsach lesions these lesions is more than 30%40% of the humeral head. Age plays a role in determining the type of bankart lesion as well as the cooccurrence of bankart and hillsachs lesions. The incidence of these lesions in the setting of glenohumeral instability is relatively high and approaches 100% in persons with recurrent anterior shoulder instability. Bankarts lesion is condition of the shoulder joint, which is characterized by the tearing of the labrum cartilage from the shoulder socket called the glenoid fossa. The objective of this study was to compare shortterm shoulder stability after arthroscopic bankart repair with remplissage versus the open latarjet procedure in patients who had chronic anterior shoulder instability with a significant hillsachs lesion. It is an indication for surgery and often accompanied by a hill sachs lesion, damage to the posterior humeral head the bankart lesion is named after english. It has been reported that engagement of the hillsachs lesion affects postoperative recurrence of anterior shoulder instability. There is detachment of the labrum with mild anterior displacement of the labroligamentous complex. A hillsachs lesion is a severe shoulder injury that might require surgical repair.
The relation between hillsachs lesion and recurrent anterior shoulder dislocation 177 discussion the incidence of hillsachs lesions in patients with recurrent anterior dislocation of the shoulder reportedly ranges between 31% and 93%4, 6, 8, 12, 17, 18, 19, 21, 22. Chronic anterior shoulder instability with significant. Xrays are sometimes normal, but they may show an injury to the bone called a hillsachs lesion. Glenoid bone loss is typically associated with the hillsachs lesion in patients with recurrent anterior shoulder instability. In this case, the arm bone slips out of the socket and is compressed against the sockets rim. Described in 1940 by two american radiologists, harold arthur hill 19011973 and maurice david sachs 19091987. A bankart lesion is an injury of the anterior inferior glenoid labrum of the shoulder due to anterior shoulder dislocation. The influence of arthroscopic remplissage for engaging. The objective of our study was to see whether there is an association between engagement on physical examination and the location or size of a hillsachs lesion and the presence and degree of glenoid bone loss as assessed on mri. Correlation between bankart and hillsachs lesions in. A hillsachs lesion, or hill sachs fracture, is a cortical depression in the posterolateral head of the humerus.
Anterior shoulder instability with engaging hillsachs. Offtrack hillsachs lesions do not increase postoperative. A hillsachs lesion, or hillsachs fracture, is a cortical depression in the posterolateral head of the humerus. This essentially converts the reverse hillsachs lesion into an extraarticular defect in the same way that remplissage converts a hillsachs lesion into an extraarticular defect, thereby decreasing the likelihood of it engaging the glenoid and causing symptoms. Fluid is seen to interpose between the detached osseous edge of anterior glenoid rim and the labroosseous fragment.
Background bankart lesions and hillsachs lesions are commonly associated with anterior shoulder dislocations. T l workman, t k burkhard, d resnick, w b goff, 2nd, z n balsara. Hillsachs lesion a dent in the back of the humeral head which occurs during the dislocation as the humeral head impacts against the front of the glenoid. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly. This study aimed to compare clinical outcomes and recurrence rates after arthroscopic bankart repair with selective remplissage procedure, between patients with offtrack and ontrack hillsachs lesions.
However, no method has been recognized as an effective preoperative means to predict engagement of the hillsachs lesion. A retrospective controlled study including ultrasound evaluation of posterior capsulotenodesis and infraspinatus strength assessment. If either lesion is diagnosed, the patient is 11 times more likely to have suffered the associated injury. The shoulder joint is a ball and socket joint, similar to the hip. Arthroscopic remplissage for engaging hillsachs lesions.
This apparent trend can be useful in predicting the presence of a bankart. Once the shoulder dislocates, it is prone to a repeat injury on even lesser impacts. The hillsachs lesion is an osseous defect of the humeral head that is. This is a divot of bone that was injured when the shoulder dislocation occurred. You doctor might have discovered this condition if youve experienced a dislocated shoulder. This injury occurs when you dislocate your shoulder. Hillsachs lesions in shoulders with traumatic anterior.
Our results suggest that the remplissage procedure performed in combination with bankart repair for anterior shoulder instability with a huge engaging hillsachs lesion can produce excellent functional results with little complications, compared to single bankart repair. Shoulder dislocation, hill sachs lesion everything you need to know dr. It is often associated with a bankart lesion of the glenoid. Assessment of coincidence and defect sizes in bankart and hillsachs lesions after anterior shoulder dislocation. The dislocation of the shoulder joint anterior can damage the connective tissue ring around the glenoid labrum. Mri has also been shown to be highly reliable for the diagnosis of hill sachs and bankart lesions. Pdf hillsachs lesion on mr arthrography of the shoulder. Bankart injury with hillsachs lesion radiology case. Regarding the severity of hillsachs lesion, the largest surface length of hillsachs lesion measured on contiguous axial mr images ranged from 9.
Sachs lesions on mri for the primary shoulder dislocation group was similar to the recurrent group 73% vs. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. Anterior shoulder dislocation, bankart lesion, hillsachs lesion, cooccurrence. The aim of this study was to investigate bankart and hillsachs lesions with mri to determine the correlation in occurrence and defect sizes of these lesions. Large bony bankart lesion 25% of the articular surface smaller lesion can be excised and repair the labral ligament complex. Biomecanica trauma, bursitis subacromiosubdeltoidea, tendinitis supraespinoso, lesion slap, lesion. The lesion is a bipolar injury, and identification of concomitant glenoid bone loss is essential to optimize clinical outcome. This injury is caused by repeated anterior shoulder subluxations. The presence of bankart lesion indicates the need for surgical repair. The long axis of the hillsachs lesion is parallel to the glenoid and engages its anterior corner. Arthroscopic remplissage and anterior bankart repair do not significantly affect infraspinatus strength while ensuring healing of. We recommend performing remplissage together with bankart repair in patients with glenohumeral instability with significant hillsachs lesions with out a glenoid.
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