ALPSA, SLAP2 tear, and GAGL lesion of shoulder

Case contributed by Dr Nafisa Shakir Batta


History of traumatic shoulder dislocation 7 years back, now has instability with repeated subluxations.

Patient Data

Age: 41 yrs
Gender: Male
Modality: MRI

Non-arthrographic MRI demonstrates anterior labral tear with a fluid cleft along the undersurface of labrum and the glenoid rim, suggesting a Perthes lesion (a non-osseous Bankart variant).

A doubtful SLAP tear is also seen.


MR arthrogram of shoulder

Modality: MRI

Arthrographic MRI delineates the thin flimsy diminutive labrum, the thickened anterior capsule, and the large pouch of sleeve periosteum of anterior glenoid. The anteroinferior labrum from 2-6 o'clock position is almost completely medially dispaced, likely consequence to repeated trauma. The medial avulsion of the labrum is compatible with an ALPSA lesion (anterior labroligamentous periosteal sleeve avulsion; a.k.a. "medialized Bankart").

A SLAP 2 tear not reaching the biceps anchor complex is seen with evidence of avulsion of the glenoid attachment of inferior glenohumeral ligament (GAHL). These findings were not conspicuous on the non-arthrographic MRI.

Case Discussion

A large Hill-Sachs deformity of posterosuperior humeral head and a denuded torn anteroinferior labrum 2-6 o'clock position with a redundant glenolabral pouch consistent with ALPSA lesion (a non-osseous Bankart variant).

A thickened irregular MGHL and anterior capsule, a SLAP tear and glenoid avulsion of IGHL (GAGL) is also evident.

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Case Information

rID: 34195
Case created: 9th Feb 2015
Last edited: 20th Sep 2015
Inclusion in quiz mode: Included

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