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iTest: young male football player with shoulder pain 2 years after traumatic shoulder injury
  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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A 23-year-old amateur football player sustained a minor fall during a training session in which he was tackled while running at low speed and fell sideways onto his flexed elbow. He sustained a traumatic injury to the non-dominant right shoulder, which had an optimal recovery after outpatient management for 6 months. A plain radiograph of the shoulder shortly after this initial injury was taken (figure 1A,B).

Figure 1

(A) Frontal and (B) trans-scapular radiographs of an anterior glenohumeral dislocation. The humeral head lies anterior and inferior to the glenoid and the articular surfaces are not congruent. A Hill–Sachs deformity (arrow) is seen as flattening of the superoposterior aspect of the humeral head. (C) Frontal and (D) lateral radiographs of a normal shoulder showing congruence of the glenohumeral articular surfaces (double arrows) and superimposed humeral head and glenoid on the oblique lateral view (oval perimeter).

Two years after management of the original injury, he presented complaining of a 1-year history of a progressively more prominent subjective sensation of instability and intermittent shoulder pain on extremes of range of motion, particularly when the arm was abducted and/or externally rotated. A magnetic resonance (MR) arthrogram was then performed to aid in the diagnosis (figure 2).

Figure 2

Fat saturated T1-weighted magnetic resonance arthrographic image revealing a minimally displaced and avulsed antero-inferior labrum in keeping with a Bankart lesion (arrow). The presence of the subscapularis tendon (arrowhead) locates this image below the equator of the humeral head.

The medical history was unremarkable and he was not taking any regular medication.

On physical examination, the patient was an otherwise healthy young man with a slightly reduced shoulder range …

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