This is Barry Bellosis, one of the musculoskeletal radiology fellows at Stanford University. A 40-year-old retired professional hurdler presents with two weeks of left shoulder pain after jumping 30 feet off a cliff into a lake, concerned for bankrupt lesion and heel-socks deformity. The patient in this case presented with this AP radiograph initially, demonstrating this osseous fragment in the inferior glenoid, likely in the anterior-inferior margin. There is also inferior subluxation of the humeral head in relation to the glenoid. The patient then underwent CT without contrast. Here is our sagittal CT reformat demonstrating the osseous bankart in its typical location, the anterior-inferior glenoid. The patient also underwent MRI without contrast. Here on our coronal MRI T2 FATSAT imaging we can see the osseous bankart in the inferior glenoid with some joint effusion. This is on a different patient, a 19-year-old male who fell while playing basketball. Anterior shoulder dislocation is the most common type of shoulder dislocation. Here we can see that the humeral head is dislocated from the glenoid. We can see some osseous fragment at the inferior aspect of the glenoid, consistent with osseous bankart. We can also see some subtle flattening of the superior lateral aspect of the humeral head. On our axillary view, we can confirm the anterior location of the humeral head by looking at the coracoid here, which is an anterior structure. The patient underwent reduction, and after reduction we can see again here the osseous irregularity at the posterior superior lateral aspect of the humeral head. This is consistent with Hill Sachs deformity and some osseous irregularity here too at the anterior-inferior glenoid, consistent with an osseous bankart. This is in a different patient who has prior dislocation. Just a quick review of our normal labrum. Here we can see this triangular hypointensity of the anterior labrum, and a little bit blunted but normal appearing posterior labrum. On this 18-year-old with history of prior dislocation, we can see that there is this glenoid labral articular disruption in the anterior-inferior glenoid, as demonstrated here. The labrum is displaced medially with periosteal stripping here, and some hypointense debris deep to the displaced labrum. There is also large joint diffusion that we can see here. Here on our axial GRE, this is at the superior aspect of the glenohedral joint, we can see this cortical defect at the posterior superior lateral aspect of the humeral head, consistent with Hill-Sacks deformity. In some instances, osseous component on patients with bankart lesion is hard to discern on MRI, and CT may be performed. This is in a different patient who underwent CT shoulder arthrogram. Here on our axial imaging, we can see this displaced osseous bankart right here. In our sagittal CT, we can again see this displaced osseous bankart, which is displaced anterior-inferiorly. This is in a different patient who has a locked posterior dislocation of the shoulder. We can see that the humeral head is perched in the posterior aspect of the glenoid. CT with 3D reconstruction is increasingly being used for estimation of the size of a bony bankart lesion as a percentage of the surface area, or assessing the relationship of humeral head to the glenoid, such as in this case.

2nd Edition, CASE 50

2nd Edition

Shoulder

shoulder dislocation

osseeous Bankart lesion

Hill Sachs deformity

CT imaging

anterior shoulder dislocation