Presentation
Volleyball player with right shoulder pain associated with recurrent instability, popping and clicking sensation after fall injury with arm in hyperabduction.
Patient Data
The non-arthrographic MRI sequences do not show any pathological findings.
MR shoulder arthrogram shows an apparent J sign with disruption of humeral attachment of posterior band inferior glenohumeral ligament (IGHL) and subsequent contrast extravasation along the medial humeral neck (floating PIGHL - see West Point classification of humeral avulsion of the glenohumeral ligament (HAGL)). The rotator cuff, long head of the biceps tendon, and glenoid labrum are normal.
Case Discussion
Identification of a HAGL is important as these lesions are difficult to evaluate and manage arthroscopically and may be an indication for open repair. Coronal MR images often show avulsion of the IGHL from the medial humeral attachment, which allows the detached end of the anterior or posterior IGHL band to fall inferiorly, transforming the normal U-shaped appearance of the IGHL into a J shape.
Case couretsy: Dr.ssa Laura Braccaioli
Radiographer: TSRM Fabio Imola
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