Humeral Avulsion of the Glenohumeral Ligament in an Adolescent: A Case Report of a Relatively Rare but Clinically Relevant Orthopedic Entity

Tiffany T Yu,Johnathan Chen

doi:10.5070/rs41346012

Abstract

Humeral avulsion of the glenohumeral ligament (HAGL) is defined as a disruption of the fibers of the inferior glenohumeral ligament at its humeral insertion. It is a relatively rare but important entity, given its diagnostic and clinical implications and growing debate around the treatment of adolescent patients particularly those who participate in sports. While well described in the orthopedic literature, HAGL has not been often discussed in the radiology literature. This case report presents classic imaging characteristics of HAGL in an adolescent football player. In addition, this case report addresses the epidemiology, the causes, the subtypes, and some aspects of treatment of HAGL.

Highlights

A17-year-old boy presented with right shoulder pain started during a football game, immediately after a fall with his arm outstretched and externally rotated
▪ Humeral avulsion of the glenohumeral ligament (HAGL) can be difficult to visualize on imaging; it is best evaluated by MR arthrography, which may demonstrate J sign, the leakage of contrast or joint fluid across the tear of the axillary pouch
HAGL is classified into four types: (1) HAGL with torn insertion of the anterior band of the inferior glenohumeral ligament (ABIGL), (2) axillary pouch HAGL with intact ABIGL, (3) bony avulsion of the IGHL (BHAGL), and (4) detached floating HAGL, the combination of HAGL with Bankart lesion.[3]

Summary

Key Points

▪ Humeral avulsion of the glenohumeral ligament (HAGL) is a disruption of the fibers of the inferior glenohumeral ligament at its humeral insertion. ▪ HAGL typically affects young athletes and adult males with shoulder overuse. ▪ HAGL is rare but critical to identify as it causes a high rate of recurrent shoulder instability. ▪ HAGL is overlooked; high index of suspicion is necessary to identify HAGL on imaging and during operation. ▪ HAGL can be difficult to visualize on imaging; it is best evaluated by MR arthrography, which may demonstrate J sign, the leakage of contrast or joint fluid across the tear of the axillary pouch. Abnormalities, and the patient was allowed to resume playing football the following week

B Axial view

Discussion

Findings

D Axial view

Conclusion