Hill-Sachs lesion, ALPSA and GAGL post anterior shoulder dislocation

Case contributed by Bálint Botz

Presentation

Recently sustained anterior shoulder dislocation. Further evaluation of ligamento-labral integrity.

Patient Data

Age: 30 years
Gender: Male
  • Posterolateral impression of the humeral head with adjacent bone edema, indicating a Hill-Sachs lesion as a consequence of the prior anterior dislocation of the humeral head. 
  • The anteroinferior labrum is detached, and is displaced medially, indicating an anterior labroligamentous periosteal sleeve avulsion lesion (ALPSA).
  • The inferior glenohumeral ligament is inhomogeneous and curled up. It is not reaching the glenoid insertion, in line with glenoid avulsion of the glenohumeral ligament (GAGL). No obvious extra-articular fluid leakage. 
  • Thin, linear high PD signal separating the posterior labrum, indicating further labral tear. 
  • Resultant joint effusion noted. 

Key images in sequence: 

1. Hill-Sachs lesion: compression and adjacent bone edema. 

2. ALPSA: the detached inferior labrum 

3. GAGL: Irregularity and buckling of the IGHL. 

4. Posterior labral tear. 

Case Discussion

Multiple ligamento-labral injuries as a consequence of single high-energy anterior shoulder dislocation injury. The presence of joint effusion paradoxically eases the diagnosis by providing an almost arthrography-like condition. 

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