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Abstract Presented at the 26th Annual Meeting of the Arthroscopy Association of North America| Volume 23, ISSUE 6, SUPPLEMENT , e4-e5, June 2007

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Posterior Humeral Avulsion of the Glenohumeral Ligament (Posterior HAGL) Lesions: Correlation Between MRI, Clinical, and Arthroscopic Findings (SS-07)

      Summary

      We concluded that posterior HAGL lesions are not significant clinically unless that patient has symptoms and a history specific for posterior instability. The majority of these lesions are identified with other pathology and probably represents a clinically insignificant finding or redundancy in the posterior structures. Treatment should be based on clinical history and findings on physical examination. The presence of a posterior HAGL on MRI does not mandate repair, especially when other problems explain the patient’s pathology.

      Purpose

      Posterior humeral avulsion of glenohumeral ligament(HAGL) has been described as a cause of shoulder instability; however, there is an incomplete understanding on the clinical significance of these lesions. The purpose of this study is to perform a retrospective review of patients diagnosed with a posterior HAGL by MRI and elucidate the clinical importance of this finding with a hypothesis that these lesions are not clinically significant.

      Methods

      Patients receiving an MRI for shoulder problems over a six year period were screened for the presence of a posterior HAGL lesion. To determine the clinical importance of this abnormality, we correlated the findings from the imaging studies to the clinical findings and arthroscopic evaluation if performed. We then contacted the patients by phone to assess their present symptoms with the visual analog scale, Tegner activity scale, and the subjective sections of the Society of the American Shoulder and Elbow Surgeons Rating Scale.

      Results

      Out of 5,476 patients that received an MRI for shoulder problems at our institution between 2000 and 2006, we identified thirteen patients with a posterior HAGL lesion. Clinical diagnosis allowed us to categorize these patients into two broad groups: seven patients with a diagnosis of rotator cuff/impingement and six patients with a diagnosis of multidirectional instability/trauma/repetitive overuse. Evaluation by radiographic imaging allowed us to organize the patients into two groups pertaining to pathologic findings: nine patients with a diagnosis of rotator cuff pathology and four patients with a diagnosis of isolated posterior labral pathology. Five of the thirteen patients received surgical intervention. Three patients underwent rotator cuff repair and were noted to have no arthroscopically visible posterior HAGL lesion. Two patients required surgical treatment of posterior capsulolabral pathology. One patient had her posterior HAGL lesion repaired and one patient underwent a reverse Bankhart repair with a posterior capsulorrhaphy. Ten of the 13 patients were contacted to assess their present symptoms. There were no significant differences noted between the clinical, radiographic, and surgical patient groups when comparing their present symptoms.

      Conclusions

      Humeral avulsion of the posterior band of the inferior glenohumeral ligament is an injury that has not been well recognized until recently due to improvements in imaging techniques (MRI) and an increased awareness of these lesions. We concluded that posterior HAGL lesions identified on radiographic imaging are not significant clinically unless that patient has symptoms and a history specific for posterior instability. The majority of these lesions are identified with rotator cuff and labral pathology and probably represents a clinically insignificant finding or redundancy in the posterior structures. Therefore, we feel that treatment should be based on clinical history and findings on physical examination, and that the presence of a posterior HAGL on MRI does not mandate repair, especially when other problems (i.e. rotator cuff pathology) explain the patient’s pain. Further study of the relationship between the MRI abnormalities and objective findings in patients diagnosed with a posterior HAGL lesion should lead to a better understanding of this lesion and assist in developing optimal treatment strategies.