Shoulder instability often involves complex injury patterns. While a Bony Bankart lesion is a classic injury to the anteroinferior labrum and glenoid rim, it’s not the only pathology to consider. Hill‑Sachs and SLAP lesions frequently occur alongside or mimic Bankart injuries. Distinguishing these conditions is critical for precise diagnosis and tailored treatment.
1. What Is a Bony Bankart Lesion?
- Mechanism: Anterior shoulder dislocation avulses the anteroinferior labrum and a rim fragment of the glenoid.
- Imaging: Best seen on CT for bone loss and MR arthrography for labral detail.
- Treatment: Arthroscopic repair or augmentation depending on bone loss percentage.
2. Hill‑Sachs Lesion
Overview
- Mechanism: Compression fracture of the posterolateral humeral head during dislocation.
- Appearance: Divot or “dent” on the humeral head.
- Key Concern: Engaging Hill‑Sachs lesions threaten recurrent instability.
Imaging
- Seen on AP X‑ray with internal rotation, but CT or MRI defines depth and size.
- Glenoid track analysis determines if the defect is “on‑track” or “off‑track.”
Management
- Small, on‑track lesions often require no specific treatment beyond Bankart repair.
- Large or off‑track lesions may need remplissage or bone graft augmentation.
3. SLAP Lesion (Superior Labrum Anterior to Posterior)
Overview
- Mechanism: Repetitive overhead activity or acute traction forces.
- Appearance: Tear of the superior labrum where the biceps tendon anchors.
- Key Symptoms: Clicking, catching, and pain in overhead positions.
Imaging
- MR arthrography is the gold standard, showing contrast undermining the superior labrum.
Management
- Arthroscopic debridement or repair depending on patient age and activity level.
- Unlike Bankart, SLAP lesions rarely involve bone loss or recurrent dislocation.
4. Comparative Imaging Clues
| Lesion | Location | Associated Injury | Imaging Modality | Key Treatment |
| Bankart | Anteroinferior glenoid rim | Glenoid bone loss | CT + MR arthrography | Labral repair ± bony augmentation |
| Hill‑Sachs | Posterolateral humeral head | Glenoid track involvement | CT/MRI | Remplissage, bone graft for large defects |
| SLAP | Superior labrum | Biceps anchor pathology | MR arthrography | Debridement or labral repair |
5. How These Lesions Interact
- Bankart + Hill‑Sachs: Common combination; both must be assessed to ensure stability.
- Bankart vs SLAP: Distinct locations but occasionally coexist, especially in overhead athletes.
- GLAD and HAGL lesions: Other variants can mimic Bankart on imaging, requiring careful differentiation.
6. Treatment Implications
- Bankart focus: Address bone loss percentage first; augment if critical.
- Hill‑Sachs consideration: Evaluate engagement risk—remplissage if needed.
- SLAP caution: Avoid over‑tightening in repair, especially in throwers, to preserve motion.
FAQs
1. Can a Hill‑Sachs lesion heal on its own?
It doesn’t “heal,” but small, stable lesions often require no intervention beyond stabilizing the Bankart lesion.
2. Do SLAP and Bankart lesions ever occur together?
Yes, combined lesions can occur after high‑energy trauma or in high‑demand athletes.
3. Why is the glenoid track concept important?
It predicts whether a Hill‑Sachs lesion will engage with the glenoid rim, guiding need for remplissage.
4. Are all Bankart lesions associated with bone loss?
No, a soft‑tissue Bankart has no bony fragment, while a Bony Bankart includes a glenoid rim fracture.
5. Which imaging test is best for differentiating these lesions?
MR arthrography for soft tissues, CT for bone assessment—often both are used together.
Bony Bankart, Hill‑Sachs, and SLAP lesions each present unique diagnostic and therapeutic challenges. Understanding their mechanisms, imaging features, and treatment strategies allows clinicians to craft a comprehensive plan. Proper identification of coexisting lesions leads to improved shoulder stability, reduced recurrence, and better functional outcomes.
