Anterior labroligamentous periosteal sleeve avulsion lesion (ALPSA)

Case contributed by Dr Mostafa El-Feky


Recurrent right shoulder dislocation.

Patient Data

Age: 17 years
Gender: Male

​Ill definition of the anteroinferior labrum is noted, reflecting underlying tear; this is associated with elevation of the related anterior scapular periosteum and medial rotation of the detached anteroinferior labrum, reflecting anterior labroligamentous periosteal sleeve avulsion lesion (ALPSA); variant of Bankart lesion.

A bony defect is noted at the posterolateral aspect of the right humeral head with mild related marrow edema, reflecting Hill Sach's bony humeral defect.

Moderate joint effusion.

A fluid signal is noted at the subacromial/subdeltoid bursa, reflecting mild bursitis.

Humeral avulsion of the glenohumeral ligament (HAGL) is noted.

The long head of biceps tendon splits into two bundles with no substance signal alteration or tear, a normal variant.

Case Discussion

Features reflecting sequelae of recurrent right shoulder dislocation; anterior labroligamentous periosteal sleeve avulsion lesion (ALPSA); a variant of Bankart lesion, Hill Sach's bony humeral defect and moderate shoulder joint effusion.

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