Anterior shoulder dislocation with Perthes lesion and HAGL

Case contributed by Mandakini Siwach


Recent shoulder dislocation.

Patient Data

Age: 30 years
Gender: Male

There is localized marrow edema 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. Localized 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 edema.

  • torn and undisplaced anterior labrum demonstrated with red arrow, stripped periosteum demonstrated with yellow arrows
  • red arrow points at defect in glenoid articular cartilage
  • red arrow points at avulsion of inferior glenohumeral ligament
  • red arrow demonstrates hyperintensity at the glenoid attachment of inferior glenohumeral ligament without obvious capsular tear
  • blue arrow points at thickened and hyperintense middle glenohumeral ligament

Case Discussion

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

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