| Title : Case 85 |
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Age / Sex : / Age / Sex : 16/M Chief complaint : Right shoulder pain
1) What is your impression? Two weeks later, you can see the final diagnosis with a brief discussion of this case. * Send Application Answers to Ja-Young Choi, MD ([email protected]) Courtesy : Woo Sun Jun, MD., Inje University Sanggye Paik Hospital Diagnosis: Hill-Sachs and ALPSA DiscussionFindings: The AP view and transscapular view of right shoulder show anterior dislocation. The trasscapular view shows flattening of posterolateral humeral head. Axial FS T1-weighted MR arthrograms demonstrated medial displacement of the labral ligamentous attachment and a Hill-Sachs fracture with subjacent bone marrow edema in the posterolateral humeral head. Oblique sagittal image shows inferior and medial shifting of the labroligamentous attachment on the glenoid. Differential Diagnosis: Bankart lesion Perthes lesion GLAD lesion Diagnosis: Anterior labral periosteal sleeve avulsion (ALPSA) and Hill-Sachs lesions in anterior shoulder dislocation Discussion: The ALPSA lesion is a tear of the anteroinferior labrum with associated capsuloperiosteal stripping. The torn labrum is rotated medially, and a small cleft or separation can be seen between the glenoid margin and labrum. The Bankart lesion is complete detachment of the labroligamentous complex. The Perthes lesion is a nondisplaced tear of the anteroinferior labrum that was attached by a linear structure with decreased signal intensity believed to be the intact medial periosteum. The GLAD lesion is a tear of the anteroinferior labrum with an attached fragment of articular cartilage but without associated capsuloperiosteal stripping. References: 1. Beltran J, Rosenberg ZS, Chandnani VP, Cuomo F, Beltran S, Rokito A.Radiographics. 1997 May-Jun;17(3):657-73. Glenohumeral instability: evaluation with MR arthrography. |
| Correct Answer | |
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| Name | Institution |
| Total Applicants (11) | |
| Correct Answer (6) | |
| 김권형: 제주한마음병원 | |
| 박소영: 분당서울대병원 | |
| 주승호: 건강보험공단 일산병원 | |
| 김완태: 서울보훈병원 | |
| 임채헌: 국군춘천병원 | |
| 최희석: 동국대학교 일산병원(전공의) | |
| Semicorrect Answer | |
| 채지원: 서울대학교병원 | |
| 이유경: 서울대병원(전공의) | |
| 박상현: 순천향대학천안병원(전공의) | |
| 김현주: 순천향대학병원 | |
| 이민희: 순천향부천병원(전공의) | |
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