J sign of humeral avulsion of the glenohumeral ligament

Case contributed by Dr Domenico Nicoletti

Presentation

Volleyball player with pain during the smash from six month.

Patient Data

Age: 20 years
Gender: Male

MR arthrogram right shoulder

TSE T1W fat-saturated MRA image shows avulsion of the humeral attachment of the inferior glenohumeral ligament (IGHL). Note the loss of the normal U-shape of the axillary recess.  The normal U-shape of the axillary pouch is distorted and is visualized as a J-shape that representing disruption of the IGHL-capsule complex. GLAD lesion is associated with detachment of the glenoid labrum (h3-6) associated with a cartilaginous defect of the anteroinferior quadrant of the glenoid.

Case Discussion

Most patients with HAGL are young with a history of traumatic instability events. However, some patients may present without a history of acute trauma. There is also a high incidence in patients subjected to repetitive overhead activities. It is impossible to see on a plain MRI scan but an MR-Arthrogram is better.

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