MRI arthrogram (gadolinium): the anterior and posterior labrum are best seen on axial images and appear as dark triangular structures.CT scan is best to evaluate bony anatomy and should be considered for the recurrent dislocator suspected of having a large Hill-Sachs or bony Bankart lesion.Garth (apical oblique) view: provides view of glenoid bone loss and Hill-Sachs lesions.Useful for evaluating the anterior glenoid rim / bony bankart lesions. Xray beam is directed 25° posterior to the horizontal plane and 25° medial to the vertical plane. West Point view: patient prone with arm in 90° abduction and neutral rotation.A/P and Lateral view in the plane of the scapula, and axillary view.Reverse Hill-Sachs lesion best seen on Grashey view with arm in external rotation. Hill-Sachs lesion:best demonstrated on plain AP radiograph in internal rotation or Stryker notch view.Hill-Sachs Lesion Xray / Diagnositc Tests See Anterior Instability Clinical Evaluation.Engaging Hill-Sachs lesion = a defect in the humeral head large enough that the edge drops over the glenoid rim when the arm is externally rotated.Reverse Hill-Sachs Lesion = impression fracture in the anterolateral humera head related to posterior instability.84% of patients with recurrent instability have Hill-Sachs lesions (Boileau P, JBJS 2006 88A:1755).Present in 90% of anterior dislocations and 25% of anterior subluxations.Hill-Sachs Lesion = Impression fracture of the posterolateral humeral head produced by contact with the anteroinferior glenoid when dislocated.Hill-Sachs Lesion Etiology / Epidemiology / Natural History 733.90 other deformity of bone and cartilage, unspecified.736.89 other deformity of arm or leg, no elsewhere classified.812.00 (fracture of humerus, upper end, unspecified).P- subsequent encounter for fracture with malunion K- subsequent encounter for fracture with nonunion G- subsequent encounter for fracture with delayed healing S42.209A - Unspecified fracture of upper end of unspecified humerus, initial encounter for closed fractureĭ- subsequent encounter for fracture with routine healing.S42.202A - Unspecified fracture of upper end of left humerus, initial encounter for closed fracture. S42.201A - Unspecified fracture of upper end of right humerus, initial encounter for closed fracture.Synonyms: Hill-Sachs lesion, reverse Hill-Sachs, compression fracture of humeral head, Etiology / Epidemiology / Natural HistoryĪssociated Injuries / Differential Diagnosis
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