HAGL with avulsion fracture of humerus

Case contributed by Dr Nafisa Shakir Batta

Presentation

History of fall on outstretched arm, pain and immobility since then.

Patient Data

Age: 49 years
Gender: Female
Modality: X-ray

This xray was done after the arthroscopic surgery and cuff repair, however it does show the greater tubercle fracture of proximal humerus.

 

Modality: CT

CT shows avulsion fracture of greater tubercle of proximal left humerus with minimal distraction.

Modality: MRI

This case clearly demonstrates a mildly displaced avulsion fracture of the greater tubercle of humerus, with marrow edema, and partially retracted subscapularis showing intramuscular hematoma. Also seen is insertion edema and partial tear of rotator cuff at supraspinatus tendon near the humeral foot plate. The myotendinous belly of supraspinatus shows fatty atrophy likely due to previous intrabursal injection or chronic subacromion impingement and tendinopathy. The  infraspinatus and to a lesser extent teres minor insertions show minimal edema.

Well delineated is the humeral avulsion of inferior glenohumeral ligament (IGHL) with a positive J-sign, lamellated periosteal stripping at posteroinferior bony glenoid but no bony fracture. There is extrasynovial spill of joint effusion/hemarthrosis into the adjacent muscle planes secondary to capsular disruption.

Minimal free fluid is seen tracking along the deep pectoral fascia and bicipital tendon.

Case Discussion

MRI reveals avulsion fracture of greater tubercle of humerus with a HAGL lesion, intramuscular hematoma at subscapularis, and partial tear at supraspinatus and teres minor insertion.

This patient underwent arthroscopic repair and the above findings were confirmed. As per the surgeon, there was a tear at the insertion of infraspinatus.

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Case Information

rID: 27509
Case created: 5th Feb 2014
Last edited: 21st Sep 2015
Inclusion in quiz mode: Included

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