Engaging Hill-Sachs Lesion: Is There an Association Between This Lesion and Findings on MRI?
ABSTRACT OBJECTIVE. 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 Hill-Sachs lesion and the presence and degree of glenoid bone loss as assessed on MRI. MATERIALS AND METHODS. Thirty-three consecutive patients (32 males and one female) with a history of anterior shoulder dislocation who underwent preoperative MRI and arthroscopy at our institution and were tested for engagement on physical examination over a 9-month period were included in the study. Two blinded readers reviewed each study independently and documented the presence and size of the Hill-Sachs lesion, location of the Hill-Sachs lesion with a modified biceps angle, and presence and size of glenoid bone loss. Statistical analysis included the Mann-Whitney, logistic regression, Pearson correlation, and intraclass correlation tests. RESULTS. Eleven patients had evidence of an engaging Hill-Sachs lesion on physical examination and 22 did not. There was no statistically significant difference between any of the dimensions or overall area of the Hill-Sachs lesion when comparing the group with an engaging Hill-Sachs lesion and the group with a nonengaging lesion (surface area, 3.60 vs 3.23 cm(3), respectively; p = 0.272). There was a trend for a larger biceps angle in the engaging group without a statistically significant difference (mean, 154.5° vs 143.9°; p = 0.069). There was a statistically significant difference in the amount of glenoid bone loss in the engaging group compared with the nonengaging group (mean, 20.2% vs 6.0%; p = 0.001). CONCLUSION. There is a significant association between an engaging Hill-Sachs lesion on physical examination and the degree of glenoid bone loss as well as a trend toward increased engagement with more medially oriented Hill-Sachs lesions. These findings show the importance of considering both the Hill-Sachs lesion and glenoid bone loss when evaluating patients with engagement.
Full-textDOI: · Available from: Jenny Bencardino, May 30, 2015
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ABSTRACT: Despite advances in the understanding of anterior shoulder instability, recurrence rates after arthroscopic and open surgery have been reported to be as high as 30%. A successful operative outcome for patients with anterior shoulder instability requires the surgeon to perform a complete preoperative evaluation based on a thorough physical examination and advanced imaging techniques. In addition to the Bankart lesion, the treating surgeon must be aware of other copathologies, such as bony lesions of the glenoid or humeral head, humeral avulsion of the glenohumeral ligament, and articular cartilage defects that can occur in concert with capsular pathology and may necessitate a change in surgical strategy. This article focuses specifically on the osseous, labroligamentous, cartilage, and rotator cuff lesions demonstrated on preoperative imaging that are important to recognize in the preoperative work-up to optimize surgical outcomes for anterior instability.Seminars in musculoskeletal radiology 09/2014; 18(4):398-403. DOI:10.1055/s-0034-1384828 · 0.95 Impact Factor
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ABSTRACT: OBJECTIVE. The purpose of this article is to review the current understanding of the underlying pathophysiology of the Hill-Sachs lesion and anterior glenoid bone loss and to discuss the role of imaging in identifying and accurately describing these injuries. CONCLUSION. Understanding the underlying mechanics of anterior shoulder instability that result in Hill-Sachs lesions and glenoid bone loss, the strengths and weaknesses of the different imaging modalities ordered for their evaluation, and the methods used to characterize these osseous injuries on imaging are essential for the radiologist in this clinical setting.American Journal of Roentgenology 06/2014; 202(6):W541-50. DOI:10.2214/AJR.13.11824 · 2.74 Impact Factor