A tennis player in her 40s presented with persistent left shoulder pain and ‘clunking’, progressively worsening over months and exacerbated by serving. The onset follows a fall onto her left outstretched hand, and she reported episodes of the shoulder ‘slipping out of place’. Physical examination revealed tenderness, positive apprehension-relocation tests and limited external rotation. A 1.5T MRI arthrography examination revealed an impaction fracture at the posterolateral humeral head (figure 1A), consistent with a Hill-Sachs lesion. The anteroinferior labrum was torn and medially retracted, suggesting an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion (figure 1A,B), a variation of the Bankart lesion, which was confirmed arthroscopically. Additionally, there was anteroinferior glenoid rim bone loss, suggesting an osseous Bankart lesion. According to the glenoid track measurement (defined below), this bipolar lesion (both a bony Bankart and Hill-Sachs lesions) was classified as off-track, indicating that the Hill-Sachs lesion is larger …

中文翻译：

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 肩部不稳定


一名 40 多岁的网球运动员出现持续性左肩疼痛和“沉闷”的声音，几个月后病情逐渐恶化，发球时病情加剧。发病是在她摔倒时左手伸出时，她报告说肩膀“滑脱”了。体格检查显示压痛、恐惧重新定位试验阳性和外旋受限。 1.5T MRI 关节造影检查显示肱骨头后外侧有撞击性骨折（图 1A），与 Hill-Sachs 病变一致。前下盂唇撕裂并向内侧回缩，提示前唇韧带骨膜袖撕脱 (ALPSA) 病变（图 1A、B），这是 Bankart 病变的一种变体，经关节镜证实。此外，还有前下关节盂边缘骨质流失，提示骨性 Bankart 病变。根据关节盂轨迹测量（定义见下文），这种双极病变（骨性 Bankart 病变和 Hill-Sachs 病变）被归类为偏离轨迹，表明 Hill-Sachs 病变更大……