CASE 98
By: Dr. Aliya Sarhan Al Barwani
HISTORY: 34-year-old male with shoulder pain and clicking.
What are the findings?
What is the name of this study?
FINDINGS:
Compression fracture involving the posterolateral aspect of the humeral head at the level of the coracoid (Hill-Sach lesion).
The anterior labrum is torn and absent (Bankart lesion).
There is contrast extension into the superior labrum in keeping with (superior labrum anterior posterior tear) SLAP tear.
Study: Direct MRI Arthrogram.
DIAGNOSIS:
Hill-Sach’s lesion and Bankart lesion.
Indications For MRA:
· Shoulder dislocation/ shoulder instability.
· To rule out labral or cartilage tear.
· To rule out intra-articular loose body.
PEARLS AND DISCUSSION:
Anterior shoulder dislocation is anteromedial dislocation of the humeral head in relation to the glenoid and is associated with Hill Sach’s (posterolateral depression of the humeral head) at the level of coracoid bone or above and Bankart/Bankart variant lesions (anteroinferior labral tear). The patient usually gives history of dislocation or instability with clicking sound.
The best modality to diagnose Hill Sach’s and Bankart lesions is MRI Arthrogram.
The MR Arthrogram of the shoulder technique is under fluoroscopy guidance: The shoulder is approached anteriorly and the superomedial aspect of the humeral head is marked under fluoroscopy. Then 22G needle is inserted under aseptic technique and local anesthesia. Diluted Gadolinium (5 to 10 ml of normal saline, 2 cc Omnipaque, 2 cc 1% Lidocaine and 0.1 cc Gadolinium) is then injected to distend the joint. MRI is performed within 30 to 40 minutes from the procedure.
FURTHER READING:
1. Demehri S, Hafezi-Nejad N. Advanced imaging of glenohumeral instability: the role of MRI and MDCT in providing what clinicians need to know. Emerg Radiol. 2016
2. Magee T. 3-T MRI of the shoulder: is MR arthrography necessary? AJR Am J Roentgenol. 2009
3. See comment in PubMed Commons belowMagee T, Williams D. Shoulder MR arthrography: which patient group benefits most? AJR Am J Roentgenol. 2004
4. Rowan KR, Andrews G. MR shoulder arthrography in patients younger than 40 years of age: frequency of rotator cuff tear versus labroligamentous pathology. Australas Radiol. 2007
