Prevalence, Pattern, and Spectrum of Glenoid Bone Loss in Anterior Shoulder Dislocation: CT Analysis of 218 Patients
James F. Griffith1,
Gregory E. Antonio1,
Patrick S. H. Yung2,
Eric M. C. Wong3,
Alfred B. Yu1,
Anil T. Ahuja1 and
Kai Ming Chan2
1 Department of Diagnostic Radiology and Organ Imaging, The Chinese University
of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St., Shatin, Hong
Kong, SAR, China.
2 Department of Orthopaedics and Traumatology, The Chinese University of Hong
Kong, Prince of Wales Hospital, Hong Kong, SAR, China.
3 Centre for Epidemiology and Biostatistics, Postgraduate Education Centre,
Faculty of Medicine, Prince of Wales Hospital, Hong Kong, SAR, China.
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Fig. 1A —Mild glenoid bone loss. Reformatted CT image of affected side
en face to glenoid articular surface in 41-year-old man with six
dislocations. Note anterior straight line (19.7 mm) (arrowheads).
Maximum width of inferior glenoid at right angles to long axis is 28.3 mm.
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Fig. 1B —Mild glenoid bone loss. Normal contralateral glenoid for
comparison. Maximum width of inferior glenoid at right angles to long axis is
31.2 mm, indicating mild (2.9 mm or 9.3%) glenoid bone loss on affected
side.
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Fig. 2A —Moderate glenoid bone loss in 19-year-old man with nine
dislocations. Reformatted CT image of affected side en face to
glenoid articular surface. Note anterior straight line (23.8 mm)
(arrowheads). Maximum width of inferior glenoid at right angles to
long axis is 23.2 mm.
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Fig. 2B —Moderate glenoid bone loss in 19-year-old man with nine
dislocations. Normal contralateral glenoid for comparison. Maximum width of
inferior glenoid at right angles to long axis is 26.3 mm, indicating moderate
(3.1 mm or 11.8%) glenoid bone loss on affected side.
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Fig. 3A —Severe glenoid bone loss in 43-year-old man with six
dislocations. Reformatted CT image of affected side en face to
glenoid articular surface shows anterior concavity (arrowheads).
Maximum width of inferior glenoid at right angles to long axis is 21.6 mm.
Note detached fracture (arrow).
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Fig. 3B —Severe glenoid bone loss in 43-year-old man with six
dislocations. Normal contralateral glenoid for comparison. Maximum width of
inferior glenoid at right angles to long axis is 31.2 mm, indicating severe
(9.6 mm or 27.5%) glenoid bone loss on affected side.
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Fig. 4 —Reformatted CT image en face to glenoid articular
surface in 15-year-old boy with six dislocations and moderate glenoid bone
loss. Note anterior straight line (17.7 mm) (arrowheads). Contour
deformity of inferoanterior aspect of glenoid is present (arrow),
consistent with reattached fracture. Maximum width of inferior glenoid at
right angles to long axis is 22.1 mm (compared with 26.4 mm on unaffected side
(not shown), indicating moderate 4.3 mm or 16.3% glenoid bone loss).
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Fig. 5A —Assessing severity of Hill-Sachs deformity. Axial images of
proximal humerus show examples of normal smooth rounder humeral contour
(A) and minimal (arrow, B), mild (arrow,
C), moderate (arrow, D), and severe (arrow,
E) degrees of Hill-Sachs deformity. Although one image is presented for
each grade, severity of Hill-Sachs deformity is assessed on serial images
rather than on a single image.
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Fig. 5B —Assessing severity of Hill-Sachs deformity. Axial images of
proximal humerus show examples of normal smooth rounder humeral contour
(A) and minimal (arrow, B), mild (arrow,
C), moderate (arrow, D), and severe (arrow,
E) degrees of Hill-Sachs deformity. Although one image is presented for
each grade, severity of Hill-Sachs deformity is assessed on serial images
rather than on a single image.
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Fig. 5C —Assessing severity of Hill-Sachs deformity. Axial images of
proximal humerus show examples of normal smooth rounder humeral contour
(A) and minimal (arrow, B), mild (arrow,
C), moderate (arrow, D), and severe (arrow,
E) degrees of Hill-Sachs deformity. Although one image is presented for
each grade, severity of Hill-Sachs deformity is assessed on serial images
rather than on a single image.
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Fig. 5D —Assessing severity of Hill-Sachs deformity. Axial images of
proximal humerus show examples of normal smooth rounder humeral contour
(A) and minimal (arrow, B), mild (arrow,
C), moderate (arrow, D), and severe (arrow,
E) degrees of Hill-Sachs deformity. Although one image is presented for
each grade, severity of Hill-Sachs deformity is assessed on serial images
rather than on a single image.
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Fig. 5E —Assessing severity of Hill-Sachs deformity. Axial images of
proximal humerus show examples of normal smooth rounder humeral contour
(A) and minimal (arrow, B), mild (arrow,
C), moderate (arrow, D), and severe (arrow,
E) degrees of Hill-Sachs deformity. Although one image is presented for
each grade, severity of Hill-Sachs deformity is assessed on serial images
rather than on a single image.
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Fig. 6 —Histogram shows spectrum of severity of glenoid bone loss in
203 patients with unilateral dislocation. Each bar represents 2.5% increment
in glenoid bone loss—that is, 2.5% change in glenoid width. Most severe
glenoid bone loss observed was 33%.
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Fig. 7 —Box-and-whisker plot shows severity of glenoid bone loss for
single and recurrent dislocations in 203 patients with unilateral dislocation.
Horizontal bar depicts median; box, interquartile range; and whiskers, range.
Glenoid bone loss was usually mild but occasionally was severe in single
dislocations. Loss was more severe (p = 0.001) and more variable in
recurrent dislocations.
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Fig. 8 —Line graph shows relationship between number of dislocations
and percentage of glenoid bone loss in 203 patients with unilateral
dislocation. Central line is fitted line mean; upper and lower lines are 95%
CIs of fitted line. Note how even severe glenoid bone loss may occur in some
patients with only one or a few dislocations.
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Copyright © 2008 by the American Roentgen Ray Society.
