HIL SACHS FRACTURE

1. CASE REVIEW HILLSACHS LESION ( IMPACTION FRACTURE ) MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARH MERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH 29 yr old male patient with H/o Recurrent anterior dislocation of the Rt shoulder.

2. HISTORY…………………………. Harold Arthur Hill and Maurice D. Sachs were 20th-century American Radiologists who described the association between an anterior dislocation of the glenohumeral joint and a compression fracture of the posterolateral aspect of the humeral head.

3. Definition …….Etiology…………. The lesion is associated exclusively with anterior shoulder dislocations Sports Falls, seizures Assaults, throwing, Reaching, pulling on the arm, or even just turning over in bed can all be causes of anterior dislocations. A Hill-Sachs lesion, also Hill-Sachs fracture, is a cortical depression in the posterior superior head of the humerus bone. It results from forceful impaction of the humeral head against the anteroinferiorglenoid rim when the shoulder is dislocated anteriorly. The average depth of Hill-Sachs lesion has been reported as 4.1 mm.

4. IMAGING OPTIONS AP Radiographs of the shoulder with the arm in internal rotation offers the best yield while axillary views and AP radiographs with external rotation tend to obscure the defect. The Stryker-Notch view, is often used specifically to look for a Hill-Sachs lesion. The sensitivity and specificity of Radiography is 65% and 67%, respectively. Ultrasonography has sensitivity of 96% and specificity of 100% MRI has been shown to be 97% sensitive and 91% specific at detecting the fractures.

5. Present case …………………… 29 Yr old male with h/o Recurrent anterior dislocations of the Rt shoulder . MR Rt shoulder done . First two axial cuts dedicatedly assessed . Exaggerated Concavity of the posterolateral aspect of the Rt humeral head is appreciated along the anteroposterior extent of the 19.5mm . Thin curvilinear streak of edema is appreciated in this region. This observation is appreciated in the first two axial cuts of the Rt humeral head and is supportive of hill sachslesion .

6. FIRST AXIAL CUT SUPRASPINATUS MUSCLE TIW , T2W SEQUENCE SECOND AXIAL CUT FOCAL DEPRESSION / IMPACTION FRACTURE ALONG THE SUPEROLATERAL ASPECT OF THE RT HUMERAL HEAD

7. FAT SATURATION SEQUENCE APPRECIATE FOCAL EDEMA AT IMPACTION FRCATURE SITE FOCAL EDEMA

8. CORONAL PLANE

9. SAGITTAL VIEW HOLISTIC LOOK …… MULTIPLANAR VIEWS AXIAL VIEW CORONAL VIEW

10. A suggested approach towards hill sachslesion/fracture ……………. History ( Anterior shoulder dislocation) . Conventional Radiography – AP radiograph with internal rotation Special views – Stryker notch view is of help. MR – Multiplanar imaging First two axial cuts important. Depth of the hill sachsdefect can be ascertained. Ancillary findings – Glenohumerallabroligamentous complex and rotator cuff assessment done.