Computed tomography scan evaluation for recurrent shoulder dislocations after sports injuries

Abstract

Shoulder dislocation is a common sporting injury. Recent studies suggest a higher rate of recurrence in the presence of glenoid rim fracture (bony Bankart lesion). The authors looked at the incidence of glenoid rim fracture, glenoid flattening and Hill-Sachs defect after recurrent shoulder dislocations. A prospective study was conducted in the Trauma and Orthopaedic Department of the Royal infirmary of Edinburgh from June 2008 to July 2009. All patients attending the specialist shoulder clinic after recurrent shoulder dislocations were evaluated with CT scan of their shoulder to look for glenoid rim fracture (bony Bankart lesion), glenoid flattening and Hill-Sachs defects. Prospective data were collected for 37 patients with a mean age of 25 years and a range of 14-40 years. 24 patients (71%) were involved in contact sports. The most common sport was football in 12 (50%) patients followed by rugby in 9 (37%) patients. Left shoulder was involved in 19 patients (51%). The CT scan showed glenoid fracture (bony Bankart lesion) in 11 patients (32%), glenoid flattening in 14 (41%) patients and Hill-Sachs defect in 29 (85%). The range of the defect was 11-45 mm. Four patients had glenoid flattening but no glenoid fracture. The type of instability was anterior in 33 (89%) patients and multidirectional instability in 4 (11%) patients. The number of dislocations range from 0 to 17 with a mean of 3 and the number of subluxations range from 0 to 35 with a mean of 4.5. The authors looked at the CT scan findings of glenoid and humeral head after recurrent shoulder dislocations in sports related injuries. Although glenoid rim fracture (bony Bankart lesion) is a risk factor for recurrence, glenoid flattening and large Hill-Sachs defects should be carefully evaluated with CT scan and appropriate stabilisation should be offered to prevent future problems.