Clinical Challenge 2: July/August, 2015

The Resolution

Diagnosis: Anterior shoulder dislocation—Hill-Sachs lesion. A Hill-Sachs lesion occurs when the humeral head impacts the glenoid rim when the shoulder is dislocated anteriorly. This appears on x-rays as a cortical depression of the posterolateral head of the humerus (arrow, Figure 2).
This patient requires sedation, reduction, and orthopedic referral. Most Hill-Sachs lesions are handled conservatively unless there is recurrent instability. Images are courtesy of Core Content in Urgent Care Medicine/Teleradiology Specialists Image Database.