0:00

Finally, now here is the actual MR of the

0:04

prior vignettes that we've been talking about.

0:08

Here is a coronal T1 fat SAT image,

0:12

and the bright stuff in the joint is the

0:13

gadolinium solution that we injected.

0:15

So this is an arthrogram, uh, image.

0:18

On your left is a fat-suppressed,

0:20

fluid-sensitive sequence.

0:21

So all the bright stuff you see over

0:22

here is actually edema from the injury.

0:25

So what we notice here is there is a divot here

0:27

at the superior aspect of the humeral head.

0:31

That's our Hill-Sachs injury from

0:34

an anterior shoulder dislocation.

0:36

There's edema all along the humeral

0:38

head, and there's relative obliteration

0:41

of the growth plate over here.

0:42

And you can notice it on the T1 FATSAT.

0:45

You see growth plate, growth plate, growth

0:47

plate, and over here there's a blob.

0:49

So there's been a crush injury

0:51

from the Hill-Sachs that has been

0:53

propagated to the growth plate.

0:55

So we know a crush injury to a growth

0:58

plate is a Salter-Harris type V injury.

1:01

So, I'm glad we got the arthrogram because

1:04

this patient had an anterior shoulder

1:06

dislocation, so there's also injury to

1:08

the anterior labral ligamentous structure.

1:11

And I want to show you that briefly,

1:13

uh, on this view right over here.

1:17

So this is our axial T1 fat-saturated image.

1:20

Again, the stuff in the, in the

1:23

joint is, is the gadolinium.

1:25

That's bright because of the contrast.

1:27

Just this image right here, we can see the

1:29

posterior labrum is nice and well-formed.

1:32

You can see some darkness over here.

1:34

But look at the anterior labrum.

1:36

It's very thickened.

1:37

You've lost the blackness.

1:39

There's thickening of the anterior periosteum.

1:43

It's been stripped off a little bit.

1:45

So this is an ALPSA lesion, A L P S A,

1:49

anterior labral periosteal sleeve avulsion.

1:53

And again, you see a little bit more of that

1:55

injury over here as you go further down.

1:57

So this is in the realm or

2:00

spectrum of a Bankart lesion.

2:03

Uh, the bone itself is fine,

2:05

so it's not a bony Bankart.

2:06

It's a soft tissue Bankart.

2:08

And as we go up, we see here's the sequela.

2:12

Sorry, as we go up, here's the

2:13

sequela of the Hill-Sachs, right?

2:16

And the crush injury to the physis.

2:18

So the mechanism of injury is a violent

2:20

anterior shoulder dislocation. And as the

2:23

shoulder was popping back in the joint,

2:26

anterior aspect of the glenoid and its

2:28

labrum smacked up against the posterior

2:31

superior aspect of our humeral head.

2:34

And that caused a crush injury to the physis

2:39

in the form of a Hill-Sachs deformity and

2:42

an injury to the anterior aspect of the

2:44

glenoid in the form of a Bankart lesion.