Shoulder Dislocations and Associated Lesions

Shoulder dislocation may occur in association with different presentation and pathology (Figure 1). We need to identify the different lesions that can result from shoulder dislocations, specifically the anterior shoulder dislocation.

Anterior shoulder dislocation is more common than posterior shoulder dislocation (Figure 2).

There is a high incidence of recurrence of shoulder dislocations in the young and a high incidence of rotator cuff tears in the elderly. Some percentage of patients may have axillary nerve palsy (5%) (Figure 3).

Two lesions that commonly occur with an anterior shoulder dislocation are a Bankart lesion of the labrum and the Hill-Sachs lesion of the humeral head, however other lesions can exist.

Different Lesions Association with Anterior Shoulder Dislocations

A Bankart lesion is an avulsion of the anterior inferior labrum (Figure 4). It is present in about 90% of traumatic shoulder dislocations.

Rotator cuff tears may occur in 80% of individuals older than 60 years of age with an anterior shoulder dislocation (Figure 5).

If the patient has an axillary nerve injury, the patient may not be able to raise the arm after a shoulder dislocation, which may occur in about 5% of cases. Inability to raise the arm due to a rotator cuff tear, especially in older patients (Figure 6) may also occur. The physician should check the sensation over the shoulder area (axillary nerve injury).

In a HAGL lesion, which is the humeral avulsion of the glenuhumeral ligament, the ligament becomes avulsed at the insertion of the humerus, and not at the mid substance or at the glenoid area (Figure 7). It may be hard to diagnose this lesion and some believe that an open surgical procedure is better.

A Hill-Sachs lesions is humeral compression fracture in the posterolateral aspect of the humeral head, which is present in about 80% of anterior shoulder dislocations (Figure 8). It may also be seen as edema on an MRI in the posterolateral aspect of the humeral head.

The ALPSA lesion is the medial displacement of the glenohumeral ligament (medialized Bankart lesion) (Figure 9).

A recurrence of the anterior shoulder dislocation may occur after surgery (Figure 10). It occurs in over 65% of patients because the lesion is not addressed. What is the lesion? The lesion is a bony defect of the scapula.

The GLAD lesion is a tear of the inferior labrum (nondisplaced) with avulsion of the adjacent glenoid cartilage (Figure 11). GLAD stands for glenoid labral articular defect. In the case of a GLAD lesion, you will find the anterior inferior labrum is avulsed but not displaced with an associated glenoid chondral defect. This lesion results from impaction of the humeral head against the glenoid. The patient will complain of persistent shoulder pain but not instability. In the GLAD lesion, the labrum is not displaced and there is no capsular stripping.

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