Thomas Henry Magee MD, Presenter: Nothing to Disclose

Shoulder injuries are common. Humeral avulsion of the glenohumeral ligament (HAGL) is an uncommon shoulder injury. HAGL lesions can be overlooked during surgery. Therefore preoperative diagnosis of the HAGL lesion on imaging is imperative. HAGL lesions are associated with anterior dislocation and instability. We report the prevalence of HAGL lesions in a large series of shoulder MR examinations. Additionally we report shoulder lesions associated with HAGL lesions. All results were correlated with arthroscopy.  

MR reports of 1000 consecutive conventional shoulder MR exams performed on patients with shoulder pain were reviewed in our information system for the word HAGL in the report. Sixteen patients had HAGL lesions reported on their MR exam. Those 16 examinations were reviewed by consensus retrospectively by two musculoskeletal radiologists. MR exams included T2 fat saturated coronal and sagittal, T1 coronal and axial proton density fat saturated images. Scans were assessed for HAGL lesions, full or partial thickness supraspinatus, infraspinatus or subscapularis tendon tears, superior labral anterior posterior (SLAP) tears and anterior or posterior labral tears. Additionally scans were assessed for Hill-Sachs lesions.

In this group of 16 patients, all had HAGL lesions on consensus review as well as on arthroscopy. Eleven patients had associated Hill-Sachs deformities, seven had subscapularis tendon tears, three had supraspinatus tendon tears and two had anterior labral tears. All of the above findings were confirmed on arthroscopy.

HAGL lesions are uncommon shoulder injuries associated with shoulder dislocation and/or instability. Common associated injuries are Hill-Sachs deformities and subscapularis tendon tears. Anterior labral tears were seen in only two cases despite Hill –Sachs deformities in eleven patients. In patients with HAGL lesions, forces associated with an anterior dislocation may disrupt the inferior glenohumeral ligament therefore diffusing the impact on the anterior labrum resulting in a protective effect on it. In patients with Hill Sachs deformities without anterior labral tears one must carefully assess for the presence of a HAGL lesion.  

One must look carefully for a HAGL lesion in patients with a Hill Sachs lesion but no labral tear. Preoperative diagnosis of a HAGL lesion is essential because they can be overlooked during surgery.

Magee, T, Prevalence of HAGL Lesions and Associated Abnormalities on Shoulder MR Examination.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11001271.html