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Case of the Month 07/09

Q1: This 32-year-old male with past medical history of one prior shoulder dislocation presented to the ED complaining of pain to his left shoulder after rolling over in bed. He was unable to lower his arm from the abducted position. After initial x-rays revealed an inferior-anterior shoulder dislocation, shoulder reduction was successfully performed using conscious sedation. Below are the post-reduction films.

What’s wrong with this picture?

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A1:

There is a bony deformity of the inferior rim of the Glenoid suggestive of a Bankhart lesion (red circle). There was a question of a Hill-Sacks lesion (black circle) although this finding was thought to be questionable as very similar in appearance to a previous normal shoulder x-ray.

Q2:

What is the significance of this lesion?

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A2:

The presence of a Bankhart lesion significantly increases the risk of recurring dislocations/shoulder instability after shoulder dislocation. There is a very interesting article in the June Annals of Emergency Medicine about the best way to manage these patients immediately post-reduction (I’ll give you a hint – it’s not what we’re doing now!!)