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Shoulder instability
  1. Clarissa Canella1,2,3,
  2. Carolina Ávila de Almeida2,3,
  3. Bruce B Forster4,
  4. Rodrigo Aguiar5
  1. 1 Department of Radiology, Federal Fluminense University Faculty of Medicine, Niteroi, Rio de Janeiro, Brazil
  2. 2 Department of Radiology, Diagnósticos da América, Rio de Janeiro, Rio de Janeiro, Brazil
  3. 3 Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
  4. 4 Department of Radiology, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
  5. 5 Department of Radiology, Federal University of Parana, Curitiba, Parana, Brazil
  1. Correspondence to Dr Carolina Ávila de Almeida, Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; carolinaaviladealmeida{at}

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A tennis player in her 40s presented with persistent left shoulder pain and ‘clunking’, progressively worsening over months and exacerbated by serving. The onset follows a fall onto her left outstretched hand, and she reported episodes of the shoulder ‘slipping out of place’. Physical examination revealed tenderness, positive apprehension-relocation tests and limited external rotation.

Imaging findings

A 1.5T MRI arthrography examination revealed an impaction fracture at the posterolateral humeral head (figure 1A), consistent with a Hill-Sachs lesion. The anteroinferior labrum was torn and medially retracted, suggesting an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion (figure 1A,B), a variation of the Bankart lesion, which was confirmed arthroscopically. Additionally, there was anteroinferior glenoid rim bone loss, suggesting an osseous Bankart lesion. According to the glenoid track measurement (defined below), this bipolar lesion (both a bony Bankart and Hill-Sachs lesions) was classified as off-track, indicating that the Hill-Sachs lesion is larger …

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  • Contributors CC, CAdA, BBF and RA were involved in the planning, conducting and writing of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.