Presentation
Recently sustained anterior shoulder dislocation. Further evaluation of ligamento-labral integrity.
Patient Data
Age: 30 years
Gender: Male
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- Posterolateral impression of the humeral head with adjacent bone edema, indicating a Hill-Sachs lesion as a consequence of the prior anterior dislocation of the humeral head.
- The anteroinferior labrum is detached, and is displaced medially, indicating an anterior labroligamentous periosteal sleeve avulsion lesion (ALPSA).
- The inferior glenohumeral ligament is inhomogeneous and curled up. It is not reaching the glenoid insertion, in line with glenoid avulsion of the glenohumeral ligament (GAGL). No obvious extra-articular fluid leakage.
- Thin, linear high PD signal separating the posterior labrum, indicating further labral tear.
- Resultant joint effusion noted.
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Key images in sequence:
1. Hill-Sachs lesion: compression and adjacent bone edema.
2. ALPSA: the detached inferior labrum
3. GAGL: Irregularity and buckling of the IGHL.
4. Posterior labral tear.
Case Discussion
Multiple ligamento-labral injuries as a consequence of single high-energy anterior shoulder dislocation injury. The presence of joint effusion paradoxically eases the diagnosis by providing an almost arthrography-like condition.
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