Humeral Avulsion of the Inferior Glenohumeral Ligament in College Female Volleyball Players Caused by Repetitive Microtrauma

Abstract

Background: Humeral avulsion of the inferior glenohumeral ligament is a rare injury resulting from hyperabduction and external rotation, and it is most commonly seen with sports-related injuries, including those from volleyball. The anterior band of the inferior glenohumeral ligament is most commonly injured (93%), whereas the posterior band is infrequently injured. The axillary pouch humeral avulsion of the inferior glenohumeral ligament as a result of repetitive microtrauma has not been yet described in the English literature. Hypothesis: Humeral avulsions of the inferior glenohumeral ligaments are identifiable in volleyball players without acute injuries, and they have a unique pathologic pattern in these athletes. Study Design: Case series; Level of evidence, 4. Methods: Four female college volleyball players with pain in their dominant shoulder and with inferior capsular laxity and/or instability—without a known history of trauma or dislocation of the same shoulder—were referred by an experienced sports medicine orthopaedic surgeon for the magnetic resonance arthrogram procedure of the same shoulder. The imaging findings were retrospectively correlated with the initial interpretation and arthroscopic findings. Results: All 4 patients had an axillary pouch humeral avulsion of the inferior glenohumeral ligament. Three had articular surface partial-thickness rotator cuff tear, and 3 had a labral tear. All were outside hitters or middle blockers who consequently performed multiple hitting maneuvers in practice and games. Conclusion: Repetitive microtrauma from overhead hitting in volleyball generates forces on the inferior capsule of the shoulder joint that may cause inferior capsular laxity and subsequent failure of the humeral side of the axillary pouch portion of the inferior glenohumeral ligament.