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What is your diagnosis in this iTest?
  1. G Ansede,
  2. J C Lee,
  3. J C Healy,
  4. A W Mitchell
  1. Radiology Department, Chelsea and Westminster Hospital, London SW10 9NH, UK
  1. Correspondence to Dr Gonzalo Ansede, Radiology Department, Chelsea and Westminster Hospital, 369 Fulham Road, Chelsea, London SW10 9NH, UK; gonzaloansede{at}gmail.com

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Answer

Acute anterior glenohumeral dislocation (figure 1).

Findings

The plain radiographs show an anterior glenohumeral dislocation (figure 1).

The MR arthrographic image (figure 2) taken 2 years after dislocation of the glenohumeral joint shows a displaced thickened antero-inferior glenoid labrum or Bankart lesion. The presence of the subscapularis tendon anteriorly helps to locate this image below the level of the glenoid equator.

Imaging features indicative of a Bankart lesion following traumatic anterior glenohumeral dislocation were confirmed on arthroscopy and the patient underwent arthroscopic Bankart repair with a speedy uneventful recovery.

Discussion

Glenohumeral instability refers to subluxation or dislocation of the humeral head and this may have a traumatic or atraumatic aetiology. In the absence of an acute episode of anterior glenohumeral dislocation, it can be a challenging diagnosis to make.

The glenohumeral joint relies on the interplay of multiple soft tissue components for stability and control as the bony restraint, mainly the relatively small shallow glenoid concavity, is minimal. The advantage of little bony restraint is a wide range of motion. The disadvantage is an inherent unstable relationship between the large humeral head and the shallow smaller glenoid, analogous to a golf ball on a tee. Therefore the glenohumeral joint offers the widest range of motion in the body but it …

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