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Shoulder Dislocation, Reverse Bankart & Hill-Sachs Lesions

by Dr. Jennifer Chen
written by Dr. Jennifer Chen

January 16,‌ 2026

5 min read

OT1225CredilleF1
Figure 1. An anterior-posterior ⁤radiograph of⁣ teh left ‍shoulder is shown demonstrating evidence of posterior dislocation with the classically described “light bulb sign” suggestive of fixed internal rotation of the humeral head.

Source: Kevin Credille, MD; Jennifer Liu, MD; Patrick C. McCulloch,⁤ MD; and Joshua Woody, ​MD

OT1225CredilleF2
Figure 2. A ⁤scapular Y radiograph​ of⁤ the left shoulder is shown demonstrating the humeral‌ head positioned posterior⁤ to the glenoid, confirming⁣ posterior glenohumeral dislocation.

Source: Kevin Credille,MD; Jennifer Liu,MD; Patrick‌ C. McCulloch, MD; and Joshua Woody, MD

While ‍admitted on the floor, the patient declined reduction attempts without sedation and⁢ was ⁣successfully closed​ reduced⁤ in the OR. She was seen by neurology to ensure‍ optimal management of⁤ her⁢ epilepsy. ‍After discharge,she was subsequently lost to follow-up and⁢ returned 4 months later with a locked posterior dislocation‌ (Figure 5).

OT1225CredilleF3
Figure‍ 3. An axial CT⁢ image is shown ⁤demonstrating a posteriorly dislocated humeral head perched on the posterior ⁢glenoid rim, with ​a large reverse hill-Sachs impaction ‌defect of the anteromedial humeral head.

Source:‌ Kevin Credille, MD; ⁢Jennifer Liu, MD; Patrick C. McCulloch,⁤ MD; and Joshua Woody, MD

OT1225CredilleF7
Figure 7. An axial proton density fat-suppressed MRI image is shown demonstrating⁣ a​ full-thickness tearing of the​ superior subscapularis tendon.

source: Kevin Credille, MD; Jennifer‍ Liu,‌ MD; Patrick⁢ C. McCulloch, MD; and Joshua Woody, MD

Humeral reconstruction ⁢was performed ‍using ⁤an ⁤osteochondral allograft. The appropriate sizing​ guide was selected to contain⁢ the defect.⁤ A guide pin was placed, and the recipient socket was reamed. The osteochondral allograft was sized, ‌prepped and pulse irrigated to remove​ marrow elements on the back table. It was ⁣then press fit into the recipient socket with excellent purchase ‍(Figure 9). Two standard​ headless ⁣compression screws were ⁣used⁢ to gain​ additional purchase given her seizure ⁤disorder. The shoulder was again‌ taken through range of motion ⁤and found to be stable.

OT1225CredilleF8
Figure 8.A sagittal T2 fat-suppressed MRI image is shown ⁤demonstrating ‍posterior ‍labral tearing.

Source: ⁣Kevin Credille, MD; Jennifer Liu, MD; Patrick C. McCulloch,MD; and Joshua Woody,MD

The subscapularis was‌ repaired to ⁢the lesser tuberosity​ footprint using two medial all-suture⁢ anchors and a lateral row of anchors. The⁤ incision was closed in layers in standard​ fashion.

postoperative course

Table of Contents

The patient has followed⁣ up at 1 month and 3 months without recurrent dislocation or​ complications. She has consistently engaged‍ with physical therapy and adhered to her rehabilitation protocol.

OT1225CredilleF9
Figure 9. the intraoperative placement of the osteochondral allograft on the ⁤anterior humeral head is shown. The graft is contoured to match the‌ native articular surface, with proper orientation and‍ press-fit‍ to restore the humeral⁣ head anatomy.

Source: Kevin Credille, MD; ⁣Jennifer Liu, MD; Patrick C. McCulloch, MD; and Joshua Woody, MD

Three-month radiographs demonstrated maintained reduction, well-positioned grafts and no hardware failure (Figures⁤ 10 and 11). At the time of a humeral osteochondral‍ allograft, as seen in this case, accomplished postoperative outcomes are achievable with appropriate patient selection, meticulous surgical technique and adherence ‌to postoperative rehabilitation⁤ protocols.

Key ⁤points:

  • Seizure-related ​posterior⁤ shoulder dislocations are‌ more common ⁣due to the relative strength of internal rotators, frequently enough resulting in reverse Hill-Sachs lesions, posterior labral tears and reverse bony‌ Bankart⁢ lesions.
  • Posterior glenoid bone loss, even as small as 11%, increases ⁤recurrence risk, prompting consideration of​ posterior⁤ glenoid bony reconstruction.
  • For‌ defects of both the posterior glenoid and anterior humerus, dual allograft reconstruction with osteochondral allograft and distal tibial allograft can⁤ be ‌a successful surgical option⁢ for the right⁢ patient.

For more information:

Kevin Credille, MD; Jennifer Liu, MD; ‍Patrick McCulloch, MD; and Joshua T. Woody, MD, can be​ reached at Houston Methodist Hospital in Houston, Texas. Credille’s email: kcredille@houstonmethodist.org. Liu’s email: jwliu@houstonmethodist.org. McCulloch’s email: pcmcculloch@houstmethodist.org. ⁣Woody’s email:‍ jtwoody@houstonmethodist.org.

Edited by⁣ Mitchell F. Bowers, ‍MD, ⁤ and​ Jennifer ⁢Liu,‌ MD. Bowers is a chief ⁢resident in orthopedic surgery at Vanderbilt University Medical Center. He will be‍ pursuing a ⁤spine ​surgery fellowship at the Leatherman Spine Institute following residency completion.Liu is a chief resident in orthopedic ​surgery ‌at Houston Methodist Hospital. she will be pursuing an adult reconstruction fellowship ​at the University of California San Francisco‌ following residency ‌completion. For more information on submitting Orthopedics ​Today Grand Rounds cases, please‌ email orthopedics@healio.com.

sources/Disclosures

Source:

Expert Submission

References:


⁤
Disclosures:
⁤ ⁤ ⁢ McCulloch ⁢reports being a paid consultant for and receiving research support from Arthrex, and being on the editorial or governing board for ⁢Orthobullets.com.⁢ Credille, Liu and Woody report no relevant financial‌ disclosures.
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