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chiroortho -> Re: Mountain Biking (July 19, 2005 3:53:00 AM)
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Hi Alex,
Couple of points:
1. The Hill-Sachs defect is essentially a small divot in the posterosuperior aspect of the humeral head that is usually seen after repeated anterior dislocations of the glenohumeral joint. It develops due to the impact of the anterior glenoid rim on the posterosuperior humeral head. See http://orthopedics.about.com/cs/othershoulder/g/hillsachs.htm Honestly it's odd that this would be read on these films, particularly since there was apparently no dislocation when the guy fell...VERY odd.
2. The yellow circle is not pointing to the subchondral cyst. The SC is actually in the glenoid, a small radiolucent circle that can be seen on both images just to the right of the humeral head in the glenoid (follow the edge of the humeral head about halfway down and you'll see it in the glenoid). Your circle is pointing to the purported bone fragment from the Hill Sachs lesion. Honestly it looks to me to be SS tendon calcification (calcific tendinosis) but it's certainly possible that it's a bone fragment. If so, it would have to suggest that the guy's shoulder dislocated when he fell then relocated on its own.
By the way subchondral cysts generally suggest DJD but may also be found in people for no apparent pathologic reason in which case they may be considered to be of limited clinical significance. Here's an example of a subchondral cyst in a dysplastic hip: http://www.totaljoints.info/subchondral_cyst.jpg
Alex, if you get a chance, run this by the radiologist and see what he says. To be candid, this is an ODD reading from the radiologist.
Have a great day and thanks for all you do here. Let me know if you talk to the radiologist about my comments. I'd be interested in how he responds.
Greg
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