HAGL lesion

Humeral avulsion of the glenohumeral ligament (HAGL) is, as the name suggests, avulsion of the inferior glenohumeral ligament (IGHL) from its humeral insertion. It can be associated with a bony avulsion fracture in which case it is referred to as bony humeral avulsion of the glenohumeral ligament (BHAGL lesion).

Epidemiology

Humeral avulsion of the glenohumeral ligament is much more frequent in young men engaged in contact sports.

Clinical presentation

Clinical presentation is usually with a history of shoulder dislocation. Anterior shoulder pain, apprehension in abduction and lateral rotation, subjective instability and crepitus are noted on examination.

Pathology

Humeral avulsion of the glenohumeral ligament most often results from anterior shoulder dislocation due to forced hyperabduction and external rotation of the arm.

Associations

• bony avulsion from the medial cortex of the humeral neck, and when combined with a Bankart lesion are often termed a “floating” inferior glenohumeral ligament: may be seen in ~ 20% of cases

Radiographic features

MRI

MRI is the modality of choice for assessment of HAGL, especially as the finding may be difficult to diagnose on arthroscopy. Typical findings include:

• avulsion of the IGHL from the proximal humerus
  • it is important to note that failure of the IGHL is more frequent at its glenoid insertion (40%) or midsubstance (35%), with only 25% tearing at the humerus
• retraction of the IGHL (so-called J sign): the normal U-shaped inferior glenohumeral recess is disrupted
• other findings associated with anterior shoulder dislocation are found in 65% cases , including:
  • subscapularis tear
  • Hill-Sachs lesion
  • Bankart lesion and/or anterior labrum injuries

Treatment and prognosis

Shoulder instability as a result of HAGL lesions is reported to occur in ~5% (range 2-10%) .

The degree of instability and the presence of other associated injuries determines whether surgical repair is required.

Differential diagnosis

• IGHL tears other than at the humeral insertion
  • 40% at the glenoid (GAGL)
  • 35% mid-substance
• adhesive capsulitis

Siehe auch:

• anterior glenolabral injuries
• Ligamentum glenohumerale inferius
• frozen shoulder
• BHAGL lesion
• j sign

und weiter:

• Bankart-Läsion
• hintere Schulterluxation
• ossäre Bankart-Läsion
• Ligamentum glenohumerale superius
• glenohumerale Instabilität
• Glenohumerale Bänder
• Ligamentum glenohumerale medius
• Labrumläsion Schulter
• bony humeral avulsion of glenohumeral ligaments
• floating AIGHL lesion of the shoulder