POLPSA lesion

Case contributed by Dr Ahmed Abdrabou


Posterior shoulder dislocation followed by pain and limited movement. The patient is basketball player

Patient Data

Age: 30 years
Gender: Male

The patient had traumatic posterior shoulder dislocation with the development of the following:

  • Reverse Hill Sachs lesion and Trough line sign as evident by depression of the anteromedial aspect of humeral head.
  • Posterior labral tear with avulsion of the posteroinferior labrum which appears hypertrophied. It remains attached to the capsule and periosteum (periosteal sleeve avulsion).
  • Posterior de-centering of the humeral head relative to the glenoid consistent with posterior instability. 
  • Marrow edema of the glenoid.
  • Os acriomiale as an incidental finding.

Diagnosis: Posterior labroligamentous periosteal sleeve avulsion (POLPSA) and posterior shoulder instability secondary to posterior shoulder dislocation.

Case Discussion

When posterior shoulder dislocation occurs, the anteromedial aspect of humeral head hits the posterior glenoid resulting in compression fracture of anteromedial humeral head (Reverse Hill Sachs lesion and trough line sign) as well as posterior labral tear, glenoid avulsion fracture and reverse Bankart lesion

In this patient the avulsed posterior labrum remains attached to a sleeve of periosteum known as Posterior labroligamentous periosteal sleeve avulsion (POLPSA), a recognized reverse Bankart variant. This lesion is associated with posterior shoulder instability and requires surgical intervention.

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Case information

rID: 25890
Published: 14th Nov 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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