Skip to main content
Top
Published in: Skeletal Radiology 1/2014

01-01-2014 | Scientific Article

Humeral avulsions of the inferior glenohumeral ligament complex involving the axillary pouch in professional baseball players

Authors: Eric Y. Chang, Heinz R. Hoenecke Jr, Jan Fronek, Brady K. Huang, Christine B. Chung

Published in: Skeletal Radiology | Issue 1/2014

Login to get access

Abstract

Introduction

Humeral avulsion of the inferior glenohumeral ligament is a rare injury in athletes and can involve different parts of the complex. Axillary pouch avulsion, in particular, has only recently been recognized in the literature, but has never been described in professional baseball pitchers.

Materials and methods

A retrospective review of professional baseball players presenting to our institution over 5 years was performed. Patients with Bankart lesions or fractures were excluded. Preoperative MRI was retrospectively correlated with the clinical and arthroscopic findings, as available.

Results

Four professional baseball pitchers were identified, all who had axillary pouch humeral avulsions of the inferior glenohumeral ligament. There was a concomitant avulsion of the anterior band in one patient. Associated findings included labral tears (n = 2) and partial thickness tear of the rotator cuff (n = 2). Three patients ultimately had their axillary pouch avulsions repaired at most recent follow-up.

Conclusions

APHAGL lesions can be seen in overhead athletes such as baseball pitchers and should be carefully considered as a potential cause of disability. Appropriate diagnosis is important to ultimately elucidate the optimal management of these lesions.
Literature
1.
go back to reference Turkel SJ, Panio MW, Marshall JL, Girgis FG. Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J bone joint Surg Am Vol. 1981;63(8):1208–17. Turkel SJ, Panio MW, Marshall JL, Girgis FG. Stabilizing mechanisms preventing anterior dislocation of the glenohumeral joint. J bone joint Surg Am Vol. 1981;63(8):1208–17.
2.
go back to reference O'Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am j sports med. 1990;18(5):449–56.PubMedCrossRef O'Brien SJ, Neves MC, Arnoczky SP, Rozbruck SR, Dicarlo EF, Warren RF, et al. The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder. Am j sports med. 1990;18(5):449–56.PubMedCrossRef
3.
go back to reference Schwartz RE, O'Brien SJ, Torzilli PA, Warren RF. Capsular restraints to anterior-posterior motion of the shoulder. Trans Orthop Res. 1987;12:78. Schwartz RE, O'Brien SJ, Torzilli PA, Warren RF. Capsular restraints to anterior-posterior motion of the shoulder. Trans Orthop Res. 1987;12:78.
4.
go back to reference Bigliani LU, Pollock RG, Soslowsky LJ, Flatow EL, Pawluk RJ, Mow VC. Tensile properties of the inferior glenohumeral ligament. J Orthopaedic Res. 1992;10(2):187–97.CrossRef Bigliani LU, Pollock RG, Soslowsky LJ, Flatow EL, Pawluk RJ, Mow VC. Tensile properties of the inferior glenohumeral ligament. J Orthopaedic Res. 1992;10(2):187–97.CrossRef
5.
go back to reference Bui-Mansfield LT, Banks KP, Taylor DC. Humeral avulsion of the glenohumeral ligaments: the HAGL lesion. Am J sports med. 2007;35(11):1960–6.PubMedCrossRef Bui-Mansfield LT, Banks KP, Taylor DC. Humeral avulsion of the glenohumeral ligaments: the HAGL lesion. Am J sports med. 2007;35(11):1960–6.PubMedCrossRef
6.
go back to reference Bach BR, Warren RF, Fronek J. Disruption of the lateral capsule of the shoulder. A cause of recurrent dislocation. J bone and joint surg British vol. 1988;70(2):274–6. Bach BR, Warren RF, Fronek J. Disruption of the lateral capsule of the shoulder. A cause of recurrent dislocation. J bone and joint surg British vol. 1988;70(2):274–6.
7.
go back to reference Nicola T. Anterior dislocation of the shoulder—the role of the articular capsule. J Bone Joint Surg. 1942;24:614–6. Nicola T. Anterior dislocation of the shoulder—the role of the articular capsule. J Bone Joint Surg. 1942;24:614–6.
8.
go back to reference Wolf EM, Cheng JC, Dickson K. Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability. Arthroscopy. 1995;11(5):600–7.PubMedCrossRef Wolf EM, Cheng JC, Dickson K. Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability. Arthroscopy. 1995;11(5):600–7.PubMedCrossRef
9.
go back to reference Taljanovic MS, Nisbet JK, Hunter TB, Cohen RP, Rogers LF. Humeral avulsion of the inferior glenohumeral ligament in college female volleyball players caused by repetitive microtrauma. Am J Sports Med. 2011;39(5):1067–76.PubMedCrossRef Taljanovic MS, Nisbet JK, Hunter TB, Cohen RP, Rogers LF. Humeral avulsion of the inferior glenohumeral ligament in college female volleyball players caused by repetitive microtrauma. Am J Sports Med. 2011;39(5):1067–76.PubMedCrossRef
10.
go back to reference Saleem AM, Lee JK, Novak LM. Usefulness of the abduction and external rotation views in shoulder MR arthrography. AJR. 2008;191(4):1024–30.PubMedCrossRef Saleem AM, Lee JK, Novak LM. Usefulness of the abduction and external rotation views in shoulder MR arthrography. AJR. 2008;191(4):1024–30.PubMedCrossRef
11.
go back to reference Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology, Part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–20.PubMedCrossRef Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology, Part I: pathoanatomy and biomechanics. Arthroscopy. 2003;19(4):404–20.PubMedCrossRef
12.
go back to reference Arciero RA, Mazzocca AD. Mini-open repair technique of HAGL (humeral avulsion of the glenohumeral ligament) lesion. Arthroscopy. 2005;21(9):1152.PubMed Arciero RA, Mazzocca AD. Mini-open repair technique of HAGL (humeral avulsion of the glenohumeral ligament) lesion. Arthroscopy. 2005;21(9):1152.PubMed
13.
go back to reference Gehrmann RM, DeLuca PF, Bartolozzi AR. Humeral avulsion of the glenohumeral ligament caused by microtrauma to the anterior capsule in an overhand throwing athlete: a case report. Am J Sports Med. 2003;31(4):617–9.PubMed Gehrmann RM, DeLuca PF, Bartolozzi AR. Humeral avulsion of the glenohumeral ligament caused by microtrauma to the anterior capsule in an overhand throwing athlete: a case report. Am J Sports Med. 2003;31(4):617–9.PubMed
14.
go back to reference Coates MH, Breidahl W. Humeral avulsion of the anterior band of the inferior glenohumeral ligament with associated subscapularis bony avulsion in skeletally immature patients. Skeletal Radiol. 2001;30(12):661–6.PubMedCrossRef Coates MH, Breidahl W. Humeral avulsion of the anterior band of the inferior glenohumeral ligament with associated subscapularis bony avulsion in skeletally immature patients. Skeletal Radiol. 2001;30(12):661–6.PubMedCrossRef
15.
go back to reference Chung CB, Sorenson S, Dwek JR, Resnick D. Humeral avulsion of the posterior band of the inferior glenohumeral ligament: MR arthrography and clinical correlation in 17 patients. AJR Am J Roentgenol. 2004;183(2):355–9.PubMedCrossRef Chung CB, Sorenson S, Dwek JR, Resnick D. Humeral avulsion of the posterior band of the inferior glenohumeral ligament: MR arthrography and clinical correlation in 17 patients. AJR Am J Roentgenol. 2004;183(2):355–9.PubMedCrossRef
16.
go back to reference Melvin JS, Mackenzie JD, Nacke E, Sennett BJ, Wells L. MRI of HAGL lesions: four arthroscopically confirmed cases of false-positive diagnosis. AJR Am J Roentgenol. 2008;191(3):730–4.PubMedCrossRef Melvin JS, Mackenzie JD, Nacke E, Sennett BJ, Wells L. MRI of HAGL lesions: four arthroscopically confirmed cases of false-positive diagnosis. AJR Am J Roentgenol. 2008;191(3):730–4.PubMedCrossRef
18.
go back to reference Blasier RB, Soslowsky LJ, Malicky DM, Palmer ML. Posterior glenohumeral subluxation: active and passive stabilization in a biomechanical model. J Bone Joint Surg Am Vol. 1997;79(3):433–40.CrossRef Blasier RB, Soslowsky LJ, Malicky DM, Palmer ML. Posterior glenohumeral subluxation: active and passive stabilization in a biomechanical model. J Bone Joint Surg Am Vol. 1997;79(3):433–40.CrossRef
19.
go back to reference Bokor DJ, Fritsch BA. Posterior shoulder instability secondary to reverse humeral avulsion of the glenohumeral ligament. J Shoulder and elbow surg / Am Shoulder and Elbow Surg [et al]. 2010;19(6):853–8.CrossRef Bokor DJ, Fritsch BA. Posterior shoulder instability secondary to reverse humeral avulsion of the glenohumeral ligament. J Shoulder and elbow surg / Am Shoulder and Elbow Surg [et al]. 2010;19(6):853–8.CrossRef
20.
go back to reference Harryman 2nd DT, Sidles JA, Harris SL, Matsen 3rd FA. The role of the rotator interval capsule in passive motion and stability of the shoulder. J bone and joint surg Am vol. 1992;74(1):53–66. Harryman 2nd DT, Sidles JA, Harris SL, Matsen 3rd FA. The role of the rotator interval capsule in passive motion and stability of the shoulder. J bone and joint surg Am vol. 1992;74(1):53–66.
Metadata
Title
Humeral avulsions of the inferior glenohumeral ligament complex involving the axillary pouch in professional baseball players
Authors
Eric Y. Chang
Heinz R. Hoenecke Jr
Jan Fronek
Brady K. Huang
Christine B. Chung
Publication date
01-01-2014
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 1/2014
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-013-1744-y

Other articles of this Issue 1/2014

Skeletal Radiology 1/2014 Go to the issue

Test Yourself: Answer

Painful left thigh mass