ALPSA, SLAP2 tear, and GAGL lesion of shoulder

Case contributed by Nafisa Shakir Batta


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

Patient Data

Age: 40 years
Gender: Male

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


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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