Anterior glenohumeral instability - ALPSA, GAGL and Hill-Sachs lesions
Presentation
Recurrent shoulder dislocation in the past.
Patient Data
Tear of anteroinferior glenoid labrum with mild superior extension. Adjacent periosteum is stripped, mildly lifted and displaced anteromedially from the anterior aspects of glenoid; however, appears intact. Tear is extending from approx. 2 to 6 o’clock positions.
Mild irregularity of adjacent glenoid articular cartilage is seen.
Minimal possible bone loss seen (approx. 5%).
Hill Sach’s compression fracture with underling marrow edema is seen involving posterolateral aspects of head of humerus. It measures approx. 22mm in transverse dimensions and 5.3mm in depth.
Partial tear of glenoid attachment of inferior glenohumeral ligament is seen involving the anterior band.
Possible sprain of middle glenohumeral ligament is also seen.
Partial thickness articular surface tear of anterior fibers of supraspinatus tendon seen at its attachment site involving approx. 30-40% thickness. Tear measures approx. 10mm in transverse and 9mm in anteroposterior dimensions. Mild subscapularis tendinosis is seen with no obvious tear.
Mild to moderate joint effusion is seen with fluid in axillary recess.
Acromion is type I. Acromioclavicular joint is unremarkable.
Bicipital tendon appears normal.
Note is made of bone island in posterior aspect of glenoid bone.
Case Discussion
Tear of the anteroinferior glenoid labrum with mild superior extension, extending from approx. 2 to 6 o’clock positions. Adjacent periosteum is stripped, mildly lifted and displaced anteromedially from the anterior aspects of glenoid; however, appears intact. Mild irregularity of adjacent glenoid articular cartilage. Findings consistent with ALPSA lesion (anterior labroligamentous periosteal sleeve avulsion).
Hill Sach compression fracture with underling marrow edema.
Partial tear of glenoid attachment of inferior glenohumeral ligament involving the anterior band consistent with GAGL (glenoid avulsion of glenohumeral ligament).
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