Posterior Humeral Avulsion of the Glenohumeral Ligament: A Clinical Review of 9 Cases

Castagna, Alessandro; Snyder, Stephen J.; Conti, Marco; Borroni, Mario; Massazza, Giuseppe; Garofalo, Raffaele

doi:10.1016/j.arthro.2007.02.006

Cited by 65 publications

(92 citation statements)

References 14 publications

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“…1,3 Posterior HAGL lesions remain infrequent, with primarily case reports and small series documented in the orthopaedic literature. 5,6,8,9 More specifically, the posterior HAGL lesion is reported to represent only 7% of cases of HAGL lesions versus anterior lesions in 93% of cases.…”

Section: Discussionmentioning

confidence: 99%

“…5,6,8,9 Anterior instability occurs with much more frequency than posterior instability, often due to Bankart anterior capsulolabral lesions, generalized laxity, or the classic anterior HAGL lesion. Nicola 4 reported the first HAGL lesion in 1942 based on cadaveric dissection.…”

Section: Discussionmentioning

confidence: 99%

“…Both open repair and arthroscopic repair have subsequently been described. 5,[7][8][9] Teres minor avulsions are rare and, when present, frequently occur in combination with supraspinatus, infraspinatus, or massive rotator cuff tears. …”

mentioning

confidence: 99%

“…5,6 Diagnosis can be difficult and is often delayed because of nonspecific shoulder pain or multiple potential etiologies for isolated posterior shoulder pain. These may include tears of the labrum, capsule, or rotator cuff or bony insufficiency.…”

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confidence: 99%

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Arthroscopic Repair of a Posterior Bony Humeral Avulsion of the Glenohumeral Ligament With Associated Teres Minor Avulsion

Smith

Nuelle

Bradley

2014

Arthroscopy Techniques

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Humeral avulsion of the inferior glenohumeral ligament (HAGL) has recently gained more recognition as a cause of shoulder instability. Posterior HAGL lesions, being much more infrequent than anterior disruptions, have only recently been documented as a notable cause of posterior instability. We detail the treatment of a previously unreported case of a posterior HAGL variant lesion consisting of a bony avulsion with involvement of the teres minor tendon. Arthroscopic fixation was facilitated by use of a "sheathless" arthroscopic approach with a 70 arthroscope and suture anchor.G lenohumeral instability can result from a wide range of factors. Increased recognition has been given to the humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion. The typical HAGL lesion most commonly described is an avulsion of the anterior inferior glenohumeral ligament from its attachment on the humerus. 1,2 This leads to anterior instability, which occurs much more frequently than posterior instability. 3,4 The posterior HAGL lesion, however, has been described as a cause of posterior shoulder instability or pain. 5,6 Diagnosis can be difficult and is often delayed because of nonspecific shoulder pain or multiple potential etiologies for isolated posterior shoulder pain. These may include tears of the labrum, capsule, or rotator cuff or bony insufficiency. Posterior HAGL lesions have been documented in association with anterior and posterior Bankart lesions; anterior, superior, and posterior labral lesions; and anterior labral periosteal sleeve avulsion lesions. Both open repair and arthroscopic repair have subsequently been described. 5,7-9 Teres minor avulsions are rare and, when present, frequently occur in combination with supraspinatus, infraspinatus, or massive rotator cuff tears. [10][11][12] To our knowledge, there is no mention in the literature of a bony posterior HAGL lesion that also involves an isolated teres minor tendon avulsion. We describe the arthroscopic treatment of a traumatic posterior HAGL variant with a bony avulsion and a lesion involving the teres minor tendon. CaseA 16-year-old right handedominant male baseball player sustained a traumatic injury to his left shoulder when he ran into an outfield fence chasing a fly ball. He forcefully struck the wall with a direct blow to the anterior and lateral aspects of the shoulder. He described the sensation of a "slip" of his shoulder but did not sustain a frank dislocation. Radiographs obtained the day of injury yielded negative findings. His examination showed good active motion with minimal rotator cuff weakness. Conservative management for a shoulder strain was subsequently initiated.After 4 weeks of physical therapy, the patient still had persistent shoulder pain, localized anteriorly, with no symptomatic improvement. His physical examination at that time showed diffuse anterior tenderness to palpation. He had full active range of motion with The authors report the following potential conflict of interest or source of funding: P.A.S. rec...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Arthroscopic Repair of a Posterior Bony Humeral Avulsion of the Glenohumeral Ligament With Associated Teres Minor Avulsion

Smith

Nuelle

Bradley

2014

Arthroscopy Techniques

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“…In the case of isolated posterior HAGL lesions, multiple portals have been described, including standard portals [9][10][11] ; modified portals such as a medialized posterior portal, an axillary pouch portal (Bhatia portal), and an anteroinferior portal 12 ; or a standard anterior portal with a more inferior posterior portal. 13 In their review of a single case of a floating PIGHL, Hill et al 3 do not address portal placement.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Repair of the Floating Posterior-Inferior Glenohumeral Ligament Lesion

Baran

Krych

Dahm

2013

Arthroscopy Techniques

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We present our technique for diagnosis and arthroscopic repair of a floating posterior-inferior glenohumeral ligament avulsion injury. A high degree of suspicion based on the patient's history, along with careful examination, should alert the surgeon to the existence of this lesion. By use of an anterolateral viewing portal and precisely placed posterior working portals, the lesion is repaired through suture anchor fixation to the humeral head and glenoid rim in a carefully sequenced fashion to achieve appropriate tension and restore the anatomy. . These rare lesions can be difficult both to diagnose and to address surgically. Unfortunately, these injuries often are missed at the time of magnetic resonance imaging and diagnostic arthroscopy and can remain undiagnosed. It has been previously proposed that the lack of success after surgical repair of posterior instability relative to anterior instability may in fact be due to missed pathology, 2 and this highlights the importance of considering this pathoanatomic injury pattern in the initial evaluation of traumatic and recurrent shoulder instability. Hill et al. 3 and Pokabla et al. 4 in 2 separate, small case series have described the floating PIGHL lesion and a technique for repair with suture anchor fixation of the Bankart lesion followed by the HAGL lesion in the former and vice versa in the latter.The technique described in this report uses modified portal placement based on careful clinical examination and/or imaging findings suspicious for a combined posterior labral and capsular avulsion injury. We outline our unique sequencing of the capsular and labral repairs to attain optimal tension in the construct and avoid overtightening the capsular structures to the humerus in the first step of the repair with the potential sequela of inability to achieve capsulolabral repair on the glenoid side in the second phase of the operation. Diagnostic and technical pearls are outlined in Table 1. Diagnosis and Surgical TechniqueIn our experience, a high level of suspicion for posterior capsular injury is essential when a patient describes a history of posterior shoulder dislocation requiring reduction. In contrast to anterior dislocation in relation to Bankart lesions, most posterior shoulder instability associated with a labral tear alone appears to be associated with subluxation rather than frank dislocation. We have found that most cases of posterior capsular disruption can be identified preoperatively using magnetic resonance imaging with intra-articular gadolinium (Fig 1), but this certainly does not obviate the need for suspicion based on history, and a careful examination both in the clinic and with the patient under anesthesia remains paramount for definitive diagnosis.The patient is placed under general anesthesia, allowing a careful physical examination in the absence of any potential guarding. We have found that patients with a floating PIGHL show a 3þ posterior load-andshift test (humeral head locks posteriorly over glenoid rim). This finding shoul...

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The glenohumeral ligaments: Superior, middle, and inferior: Anatomy, biomechanics, injury, and diagnosis

Fox

Schär

et al. 2021

Clinical Anatomy

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The three glenohumeral ligaments (superior, middle, and inferior) are discrete thickenings of the glenohumeral joint capsule and are critical to shoulder stability and function. Injuries to this area are a cause of significant musculoskeletal morbidity. A literature search was performed by a review of PubMed, Google Scholar, and OVID for all relevant articles published up until 2020. This study highlights the anatomy, biomechanical function, and injury patterns of the glenohumeral ligaments, which may be relevant to clinical presentation and diagnosis. A detailed understanding of the normal anatomy and biomechanics is a necessary prerequisite to understanding the injury patterns and clinical presentations of disorders involving the glenohumeral ligaments of the shoulder.

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Posterior Humeral Avulsion of the Glenohumeral Ligament: A Clinical Review of 9 Cases

Cited by 65 publications

References 14 publications

Arthroscopic Repair of a Posterior Bony Humeral Avulsion of the Glenohumeral Ligament With Associated Teres Minor Avulsion

Arthroscopic Repair of a Posterior Bony Humeral Avulsion of the Glenohumeral Ligament With Associated Teres Minor Avulsion

Arthroscopic Repair of the Floating Posterior-Inferior Glenohumeral Ligament Lesion

The glenohumeral ligaments: Superior, middle, and inferior: Anatomy, biomechanics, injury, and diagnosis

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