Shoulder – Labral tear

CASE HISTORY

21-year-old man who presents with college football injury collided with another player shoulder pain. Question Bankart tear.

TECHNICAL FACTORS

Long- and short-axis fat- and water-weighted images were performed. 

KEY IMAGES

This case has no key images.

CASE FINDINGS

• ROTATOR CUFF:
  • Supraspinatus infraspinatus teres minor and subscapularis are intact and normal in size and configuration. 
• BICEPS:
  • Biceps including the biceps labral anchor takeoff and superior labrum the intra-articular non-bursal line portion extra-articular bursal line portion and the portion descending in the bicipital groove are unremarkable. Medial and lateral walls of the biceps groove including the lesser and greater tuberosity of the humerus are unremarkable. 
• ARCHES:
  • Acromion is flattened. Mild acromioclavicular joint arthropathy. Coracohumeral and coracoacromial ligaments are intact. 
• LABRUM/CAPSULE:
  • Anterior/inferior labral tear with stripping of the periosteum compatible with a soft Bankart and a three-part lesion. Labral injury extends anteriorly from approximately the 10-o’clock position to the 6-o’clock position. Marked associated surrounding fluid and edema. In addition chronic tiny superior labral injury. 
• GLENOHUMERAL JOINT:
  • Glenohumeral joint appears normal without glenohumeral arthropathy erosive change or loose body.  Inferior glenohumeral ligament is intact.  Middle glenohumeral ligament appears torn.   
• BONE MARROW:
  • Bone marrow edema along the posterolateral humeral head is consistent with a Hill-Sachs fracture without depressive deformity or bone loss compatible with on track type of deformity.
• MUSCLES:
  • Muscles appear normal in size contour and signal intensity. 
• NEUROVASCULAR:
  • No signs of entrapment neuropathy in the quadrilateral space suprascapular notch space region of the long thoracic nerve or brachial plexus distribution.

CASE CONCLUSION

Hill-Sachs fracture with soft Bankart injury with periosteal stripping compatible with three-part  or “triple lesion” injury (labroligamentous; labrocapsular; and periosteal). Labral injury extends anteriorly from the 10-o’clock position to the 6-o’clock position.  No depressive deformity or bone loss and findings compatible with on track type of deformity.