Anterior shoulder dislocation with Perthes lesion and HAGL

Case contributed by Dr. Mandakini Siwach

Presentation

Recent shoulder dislocation.

Patient Data

Age: 32
Gender: Male

There is localised marrow oedema over the posterosuperior aspect of the humeral head consistent with a Hill-Sachs lesion.

There is a tear involving the anterior labrum. The tear extends between 2 o'clock and 5 o'clock positions. There is a fluid signal intensity cleft  between the detached labroligamentous complex and the anterior lip of glenoid. The fluid filled cleft is seen to extend along the anterior surface of the glenoid consistent with periosteal stripping. No displacement of the labroligamentous complex is noted. The appearance is consistent with Perthes lesion.

There is involvement of the adjacent glenoid cartilage (GLAD).

The adjoining middle  glenohumeral ligament appears thickened and hyperintense and is likely torn.

There is significant thickening and hyperintensity of the anterior and posterior bands of the inferior glenohumeral ligament. Localised soft tissue edema is identified adjacent to the humeral attachment of the posterior band of the inferior glenohumeral ligament  consistent with a capsular tear (HAGL). Subtle hyperintensity is also seen in the inferior glenohumeral ligament at its glenoid attachment.

Mild glenohumeral joint effusion is identified with fluid in the subscapularis recess.

There is a partial thickness bucket-handle tear involving the superior labrum between 11 and 12 o'clock positions.The biceps anchor appears intact. 

The posterior labrum is normal. 

The supraspinatus tendon shows diffuse hyperintensity close to its insertion consistent with tendinosis/contusional oedema.

Torn and undisplaced anterior labrum, stripped periosteum, defect in glenoid articular cartilage, avulsion of inferior glenohumeral ligament, hyperintensity at the glenoid attachment of inferior glenohumeral ligament without obvious capsular tear, thickened and hyperintense middle glenohumeral ligament.

Case Discussion

The present case demonstrates multiple typical abnormalities resulting from anterior shoulder dislocation.

PlayAdd to Share

Case information

rID: 53957
Case created: 15th Jun 2017
Last edited: 22nd Jun 2017
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.