Hill‑Sachs and Bankart Lesions
(Fractures and eponymous lesions - anterior glenohumeral instability)
Overview
Hill‑Sachs and Bankart lesions are the characteristic bony and soft‑tissue injuries that follow anterior shoulder dislocation. Their recognition in the emergency department is important because they are markers of prior dislocation and predictors of recurrent instability.
Immediate ED care is driven by safe reduction, neurovascular assessment and appropriate disposition; advanced imaging and operative planning are usually arranged after the acute episode (RCEM; MoD guidance).
Anatomy and mechanism
The glenohumeral joint sacrifices bony congruity for range of motion and depends on the labrum, capsule and surrounding muscles for stability. In anterior dislocation the humeral head is forced anteroinferiorly against the glenoid rim, producing:
- A posterolateral humeral‑head impaction (Hill‑Sachs) from the humeral head striking the anteroinferior glenoid.
- Avulsion of the anteroinferior labrum with or without glenoid rim fracture (Bankart or bony Bankart).
These defects increase the risk of recurrent dislocation when they are large enough to engage the glenoid rim during abduction and external rotation.
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Hill‑Sachs lesion
Description
A Hill‑Sachs lesion is a compression (impaction) fracture or cortical depression of the posterolateral humeral head caused by impact with the anteroinferior glenoid during anterior dislocation.