17-year-old male with known dislocation

Case
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Anterior shoulder dislocation.

Long- and short-axis fat- and water-weighted images were obtained before and after contrast administration. 10cc of OptiMARK injected. 

  • There is quite extensive capsulolabral injury demonstrated in the anterior and anterior-inferior aspect of the glenoid rim from 2:30-o’clock to 9:30-o’clock inferiorly. Anteriorly and inferiorly Bankart or ALPSA lesion.  Corresponding Hill-Sachs lesion is demonstrated with underlying bony contusion measuring approximately 17 x 3.5mm bony defect in the posterosuperior aspect of the humeral head. Mild posterior subluxation of the humeral head is demonstrated. No osteochondral lesion is identified in the glenohumeral joint. 
  • A bifid biceps long head tendon is favored over split tear. The rotator cuff is intact without tendinopathy or tears. Downsloping acromion without findings of lateral impingement. The acromioclavicular joint is intact. Mid outlet mild stenosis is demonstrated due to hypertrophy of clavicular end. No myoedema or muscle atrophy is seen. Plastic and lax inferior glenohumeral ligament is demonstrated. The superior glenohumeral ligament is unremarkable. Mid-glenohumeral ligament is also sprained.

Stigmata of anterior shoulder dislocation:

  • Extensive inferior capsulolabral injury from 2:30-o’clock to 9:30-o’clock. Anteroinferiorly soft tissue Bankart equivalent or ALPSA lesion and periosteal stripping for 2cm distance.
  • Detached inferior labroligamentous complex series 601 image 10. Subtle cartilage rim injury at labral base. 
  • Corresponding 17 x 17 x 3.5mm Hill-Sachs lesion.   No osteochondral defect in the glenohumeral joint. No substantive glenoid bone loss.
  • Mild posterior capsular stripping.