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Humeral Avulsions of the Glenohumeral Ligament: Imaging Features and a Review of the Literature

Liem T. Bui-Mansfield1,2,3, Dean C. Taylor4, John M. Uhorchak4 and Joachim J. Tenuta4

1 Department of Radiology, Keller Army Community Hospital, 900 Washington Rd., West Point, NY 10996-1197.
2 Department of Radiology, Division of Radiologic Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088.
3 Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799.
4 Orthopaedic Surgery Service, Keller Army Community Hospital, West Point, NY 10996-1197.



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  		Fig. 1A. —32-year-old man with recurring anterior shoulder dislocation since initial injury during pugil-stick training. Anterior radiograph of externally rotated right shoulder shows small bony fragment (white arrow) just medial to humeral neck. Note subtle curvilinear radiolucent defect (black arrow) in medial cortex, which was donor site of lesion associated with bony humeral avulsion of glenohumeral ligament.

 


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  		Fig. 1B. —32-year-old man with recurring anterior shoulder dislocation since initial injury during pugil-stick training. West Point view of right shoulder reveals no Bankart lesion. Note small bony fragment (arrow) superimposed on proximal humerus.

 


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  		Fig. 2A. —19-year-old man with initial anterior shoulder dislocation. West Point view of left shoulder shows subtle Bankart lesion (arrow).

 


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  		Fig. 2B. —19-year-old man with initial anterior shoulder dislocation. Thirty-degree arthroscopic image of left shoulder from posterior shows exposed subscapularis muscle (S) seen through HAGL defect (arrowhead). Note humerus (H) to left. L = lateral, M = medial.

 


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  		Fig. 3A. —22-year-old man who underwent open anteroinferior capsular shift for anterior shoulder instability 6 weeks before being involved in motor vehicle crash. Patient fell 1 week before crash. Anterior radiograph of internally rotated right shoulder shows comminuted displaced fracture of clavicle and osteochondral fracture of humeral head (arrow).

 


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  		Fig. 3B. —22-year-old man who underwent open anteroinferior capsular shift for anterior shoulder instability 6 weeks before being involved in motor vehicle crash. Patient fell 1 week before crash. Oblique coronal T2-weighted MR image obtained with fat suppression of right shoulder reveals J-shaped anterior band of inferior glenohumeral ligament (curved white arrow) and extravasation of joint fluid through humeral detachment (black arrow). Note associated osteochondral injury of humeral head (straight white arrow).

 


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  		Fig. 3C. —22-year-old man who underwent open anteroinferior capsular shift for anterior shoulder instability 6 weeks before being involved in motor vehicle crash. Patient fell 1 week before crash. Oblique coronal T2-weighted MR image obtained with fat suppression of right shoulder shows complete rupture of subscapularis tendon (black arrow). Note marked hemorrhage (white arrow) surrounding clavicle.

 


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  		Fig. 4. —41-year-old man who fell while playing in ice hockey game. Oblique coronal T2-weighted MR image obtained with fat suppression of left shoulder shows J-shaped anterior band of inferior glenohumeral ligament labral complex (white arrow) and extravasation of fluid through humeral detachment (black arrow).

 


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  		Fig. 5A. —20-year-old man who had anterior shoulder dislocation during wrestling. Obtained immediately after reduction of shoulder, anterior radiograph of externally rotated right shoulder dislocation shows osteochondral defect (arrow) adjacent to greater tuberosity. Bone island (arrowhead) can be seen in humeral head.

 


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  		Fig. 5B. —20-year-old man who had anterior shoulder dislocation during wrestling. Axial T1-weighted MR image confirms presence of osteochondral injury of humeral head (arrow). Arthroscopy did not reveal Hill-Sachs lesion.

 


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  		Fig. 6. —Schematic drawing of shoulder joint capsule shows location and extent of inferior glenohumeral ligament labral complex. A = anterior, P = posterior, B = biceps brachii tendon, SGHL = superior glenohumeral ligament, MGHL = middle glenohumeral ligament, IGHLC = inferior glenohumeral ligament labral complex, AB = anterior band, PB = posterior band, PC = posterior capsule. Numbers are clock referents. (Reprinted with permission from [11])

 


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  		Fig. 7A. —Drawings of proximal humerus show two types of attachment of inferior glenohumeral ligament labral complex. (Reprinted with permission from [11]) Collarlike attachment (arrow) of inferior glenohumeral ligament labral complex.

 


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  		Fig. 7B. —Drawings of proximal humerus show two types of attachment of inferior glenohumeral ligament labral complex. (Reprinted with permission from [11]) V-shaped attachment (arrow) of inferior glenohumeral ligament labral complex.

 


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  		Fig. 8A. —17-year-old man who fell on his left outstretched arm and had recurring shoulder instability. Anterior radiograph of externally rotated left shoulder reveals large bone fragment (arrow) adjacent to glenohumeral joint that was thought to be bony HAGL lesion. Diagnostic arthroscopy (not shown) did not show bony HAGL lesion.

 


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  		Fig. 8B. —17-year-old man who fell on his left outstretched arm and had recurring shoulder instability. West Point view of left shoulder shows Bankart lesion (arrow). No bony fragment can be seen overlying proximal humerus.

 

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