title: Hill-Sachs lesion location: does it play a role in engagement?
abstract: OBJECTIVE
  To see if there is an association between engagement on physical examination (PE) and the location of the Hill-Sachs lesion (HSL) as assessed by the modified biceps angle.
  
  
  METHODS
  Sixty-two patients with a history of anterior shoulder dislocation, who underwent preoperative MRI and arthroscopy at our institution and were tested for engagement on PE, were collected. Two musculoskeletal radiologists reviewed the MR studies, noting the presence of an HSL and documenting the location of the HSL with the modified biceps angle. Statistical analysis included the Mann-Whitney (MW) test and ROC (receiver-operating characteristic) curve.
  
  
  RESULTS
  Of 62 patients, there were 58 males and 4 females with a mean age of 30 (range 18-59 years). Twenty patients demonstrated engagement on PE, while 42 did not. All patients had evidence of an HSL on MRI and arthroscopy. The mean biceps angle for the engaging group was 151.5 ± 13.9°, and 142.4 ± 17.3° for the non-engaging group. The biceps angle was statistically significantly higher among patients who had engagement compared to those who did not (p = 0.027). Overall, diagnostic accuracy was highest for a biceps angle >149°, which resulted in a sensitivity of 70% and specificity of 67%.
  
  
  CONCLUSIONS
  The modified biceps angle, as measured on MRI, was significantly higher in patients who demonstrated engagement on physical examination than in those who did not. This supports the theory that the location of the Hill-Sachs lesion may play a role in engagement and may be its most important characteristic when determining its significance.
authors.affiliation: Department of Radiology, NYU Langone Medical Center, 660 First Avenue, New York, NY, 10016, USA, Soterios20@gmail.com.
authors.forename: Soterios
authors.initials: S
authors.lastname: Gyftopoulos
authors.forename: Annie
authors.initials: A
authors.lastname: Wang
authors.forename: James
authors.initials: J
authors.lastname: Babb
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012783:Shoulder Dislocation / Q000473:pathology*; D012785:Shoulder Joint / Q000473:pathology*; D055815:Young Adult
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