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MRI of HAGL Lesions: Four Arthroscopically Confirmed Cases of False-Positive Diagnosis

¹ Department of Orthopaedics, University of Pennsylvania, Philadelphia, PA.
² Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA.
³ Present address: Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA.
⁴ University of Pennsylvania School of Medicine, Philadelphia, PA.
⁵ Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, University of Pennsylvania, Wood Bldg., Floor 2, 34th St. and Civic Center Blvd., Philadelphia, PA 19104-4399.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —14-year-old girl (patient 1) with recurrent right shoulder pain and painful popping sensation. Coronal oblique fat-saturated T1-weighted MR arthrogram shows apparent "J" sign with disruption of humeral attachment of inferior glenohumeral ligament and subsequent contrast extravasation along medial humeral neck. Arrows show disruption of humeral attachment of inferior glenohumeral ligament complex outlined by "white" contrast dye in glenohumeral joint.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —14-year-old girl (patient 1) with recurrent right shoulder pain and painful popping sensation. Arthroscopic image depicts rent in inferior glenohumeral ligament without extension to humeral insertion.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —14-year-old girl (patient 2) with 3-month history of right shoulder pain associated with popping and clicking sensation. Coronal oblique fat-saturated T1-weighted MR arthrogram shows apparent "J" sign with disruption of humeral attachment of inferior glenohumeral ligament and subsequent contrast extravasation along medial humeral neck.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —14-year-old girl (patient 2) with 3-month history of right shoulder pain associated with popping and clicking sensation. Arthroscopic image shows rent in inferior glenohumeral ligament in line with ligament fibers. Rent does not extend to humeral insertion.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —14-year-old girl (patient 2) with 3-month history of right shoulder pain associated with popping and clicking sensation. Arthroscopic image shows side-to-side repair of inferior glenohumeral ligament defect.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —25-year-old woman (patient 3) with right shoulder pain and history of traumatic injury 6 years earlier in motor vehicle accident. Coronal oblique fat-saturated T2-weighted MR arthrogram shows strands of tissue in axillary pouch thought to represent tear of inferior glenohumeral ligament and subsequent contrast extravasation along medial humeral neck.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —25-year-old woman (patient 3) with right shoulder pain and history of traumatic injury 6 years earlier in motor vehicle accident. Arthroscopic image shows tear of posterior labrum.

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —25-year-old woman (patient 3) with right shoulder pain and history of traumatic injury 6 years earlier in motor vehicle accident. Arthroscopic image shows repair of posterior labrum.

View larger version (160K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —21-year-old man (patient 4) who presented with continuing shoulder pain and limited range of motion after traumatic anterior dislocation of right shoulder 4 weeks earlier. Coronal oblique fat-saturated T2-weighted MR image appears to show disruption of inferior glenohumeral ligament at its humeral insertion (arrow), with associated soft-tissue edema tracking along medial humeral neck.

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —21-year-old man (patient 4) who presented with continuing shoulder pain and limited range of motion after traumatic anterior dislocation of right shoulder 4 weeks earlier. Arthroscopic image shows anterior Bankart lesion.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —21-year-old man (patient 4) who presented with continuing shoulder pain and limited range of motion after traumatic anterior dislocation of right shoulder 4 weeks earlier. Arthroscopic image shows repair of anterior Bankart lesion.

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