Lesions of the Shoulder—Hill-Sachs Lesion


The Hill-Sachs lesions is a dent in the posterior aspect of the humeral head, which occurs during an anterior shoulder dislocation. The humeral head impacts against the front of the glenoid cavity of the scapula. A Hill-Sachs lesion is usually associated with a Bankart lesion. A Bankart lesion is the most common lesion of anterior shoulder instability following dislocation. It involves an avulsion of the anterior inferior labrum. The Hill-Sachs lesion can range from a small to large indentation and the size of the lesion can affect the treatment given to the patient. The larger the Hill-Sachs lesion, the more likely that the shoulder will be unstable and the more likely to

bankart lesiondislocate again (recurrent dislocations). The larger the Hill-Sachs lesion is, the more likely that the glenoid labrum and joint capsule have a significant tear.

Treatment for a small sized Hill-Sachs lesion of less than 20% can usually be treated nonoperatively. A medium sized Hill-Sachs lesion—a defect greater than 25%– may require an arthroscopic or open remplissage procedure (may be performed in combination with Bankart repair). The defect is “filled in” with the posterior capsule and rotator cuff. Larger sized Hill-Sachs lesions are rare. Lesions greater than 40% are usually filled with bone or metal.



Q-Angle of the Knee

A well-functioning knee joint is important for mobility. The knee must be able to support the weight of the body during activities such as walking or running.

What is a Q-angle? knee anatomy

The Q Angle, or quadriceps angle, is the angle between the quadriceps tendon and the patellar tendon. An increased Q-angle is a risk factor for patellar subluxation.

How do you measure the Q-angle?

First, you will need to find the patella and its border. Then, you will need to find the center of the patella. You will then need to find the tibial tubercle and draw a line from the ASIS to the center of the patella and a second line from the tibial tubercle through the center of the patella.

normal qThe Q-angle is formed in the frontal plane by the two line segments. It is the angle formed by a line drawn from the Anterior Superior Iliac Spine (ASIS) to the center of the patella. A second line is drawn from the center of the patella to the tibial tubercle. The angle formed by the two lines is called the Q-angle. The normal Q-angle is variable. In males, the angle is usually 14° and 17° in females. A wider pelvis and an increased Q-angle in females is linked to knee pain, patellofemoral pain, and ACL injury. The alignment of the patellofemoral joint is effected by the patellar tendon length and the Q-angle. It is best to measure the Q-angle with the knee in extension as well as flexion.increased q

A larger Q-angle plus a strong quadriceps contraction can dislocate the patella. The Q-angle is increased by:

  • Genu valgum
  • External tibial torsion
  • Femoral anteversion
  • Lateral positioned tibial tuberosity
  • Tight lateral retinaculum

A CT scan study of the patellofemoral articulation is found to be very helpful.

Bilateral Proximal Biceps Tendon Rupture

Bilateral proximal biceps tendon ruptures are rare. The majority of biceps tendon ruptures involve the long head of the biceps and occurs proximally. When the tendon ruptures, the biceps muscle bunches tendonup in the distal portion of the arm. Ruptures cause a “Popeye muscle” appearance. Both proximal heads of the biceps muscle arise from the scapula. The short head of the biceps originates from the coracoid process. The long head of the biceps originates from the supraglenoid tubercle just above the shoulder joint. Rupture of the long head of the biceps tendon occurs at the bicipital groove and the muscle thebicepsn moves towards the elbow (popeye muscle). The short head of the biceps remains attached to the coracoid. Usually, there is less disability with the proximal biceps tendon rupture than the distal biceps tendon rupture.

The patient may experience cramping, pain, and cosmetic problems with proximal biceps tendon ruptures. The physician may need to perform a surgical procedure called tenodesis of the biceps tendon especially if there is an associated rotator cuff tendon pathology.


Osteoarthritis of the Fingers- Heberden’s Nodes

Osteoarthritis is a degenerative condition of the cartilage. There is no clear etiology. Osteoarthritis is not related to tumors, inflammation, infection, gout, or trauma. Osteoarthritis is different from rheumatoid arthritis—which is an inflammatory condition. This distal interphalangeal joint (DIP) is the joint that is most often involved with osteoarthritis. The trapeziometacarpal joint (TM) is the most involved joint with osteoarthritis. When the trapeziometacarpal joint is involved, it causes pain with a weak pinch and grip.


Osteoarthritis of the fingers involves the following:

DIP (Heberden’s Nodes) – Heberden’s nodes are bony swellings (osteophytes) that can DIPdevelop in the distal interphalangeal joints (DIP) due to the effects of osteoarthritis on these joints. Heberden’s nodes are a sign of osteoarthritis caused by osteophyte formation (bony outgrowth) of the articular cartilage in response to repeated microtrauma at the joint. Heberden’s nodes are more common in women then in men.

PIP (Bouchard’s Nodes) – Bouchard’s nodes are also associated new pipwith osteoarthritis and they are similar bony growths which develop in the proximal interphalangeal (PIP) joints. Bouchard’s nodes, like Heberden’s nodes, may or may not be painful. Swollen, hard, and painful finger joints (Heberden’s and Bouchard’s nodes) is the classical sign of DIP and PIP joint osteoarthritis.


Mucous Cyst– Small, fluid-filled sacs that form between the DIP joint of the finger and the bottom of the fingernail are another sign of osteoarthritis. The best treatment is a surgical excision of the cyst and removal of the underlying osteophyte to decrease the risk of recurrence.