Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticlePosterior Humeral Avulsion of the Glenohumeral Ligament: A Clinical Review of 9 Cases
Section snippets
Methods
Between January 2001 and December 2003, 16 consecutive patients underwent an arthroscopic repair of a PHAGL lesion. In 7 patients, the PHAGL lesion was found after a previous shoulder surgery, and they were excluded from this study. Six of these patients underwent previous anterior shoulder stabilization, open in 4 and arthroscopic in the other 2 cases. One patient underwent thermal capsule shrinkage to treat multidirectional shoulder instability.
The remaining 9 patients were retrospectively
Associated Abnormalities
In 3 cases, the PHAGL lesion was associated with a posterior Bankart lesion that was repaired during the same surgical procedure. In 1 case, a SLAP type III lesion was treated with debridement of the bucket-handle labral tear and repair of the SLAP lesion. An anterior Bankart lesion was found in 1 case and an ALPSA lesion was found in another; both of these lesions were repaired during the same surgical procedure. Only in the remaining 3 cases (33%) was a PHAGL present as an isolated lesion.
Discussion
The PHAGL lesion has recently been recognized as a cause of shoulder pain, discomfort, and posterior instability.8, 9, 10 The IGHL plays a key role in anterior shoulder instability. The avulsions of this ligament and of the labrum (Bankart lesion) from the glenoid have been established as primary lesions in anterior inferior instability in both clinical and cadaveric studies.12, 13 Bankart lesions are thought to be responsible for anterior shoulder instability in 45% to 100% of cases.
Conclusions
This study suggests that clinical diagnosis of PHAGL lesions is very difficult because specific findings are lacking, and symptoms and signs can be variable because of associated lesions. It can be an isolated cause of posterior instability but also be a part of the spectrum of shoulder instability. Proper recognition of the capsular avulsion is essential and, because physical examination can be misleading, a gad-MRI or an arthroscopic examination can help with the diagnosis. We repaired the
References (19)
- et al.
Arthroscopic repair of a posterior humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion
Arthroscopy
(2004) - et al.
Humeral and glenoid detachment of the anterior inferior glenohumeral ligament: A cause of anterior instability
J Shoulder Elbow Surg
(1997) Anterior dislocation of the shoulder: The role of the articular capsule
J Bone Joint Surg Am
(1942)- et al.
Operative stabilization of posterior shoulder instability
Am J Sports Med
(2005) - et al.
Posterior labral injury in contact athletes
Am J Sports Med
(1998) - et al.
Recurrent posterior instability (subluxation) of the shoulder
J Bone Joint Surg Am
(1984) - et al.
Clinical evaluation of shoulder problems
- et al.
The treatment of posterior subluxation in athletes
Clin Orthop Relat Res
(1993) - et al.
Posterior glenohumeral instability
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Outcomes following arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL) lesion: A systematic review
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2019, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :The University of California, Los Angeles, score was not reported in any of the included studies with BC positioning. The University of California, Los Angeles, scores for patients treated in LD was reported in 4 studies (93 patients) and ranged preoperatively from 16.3 to 21.9 and postoperatively from 32.6 to 34.7.10,27,30,41 The visual analog scale score was reported in1 BC study (32 patients) and 11 LD studies (768 patients). Preoperative values for BC were 7.4, and for LD, ranged from 3.5 to 6.8.
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2018, Shoulder and Elbow Injuries in Athletes: Prevention, Treatment and Return to Sport
The authors report no conflict of interest.