Reverse humeral avulsion of glenohumeral ligaments (rHAGL)

Abstract

The name reverse HAGL lesion is used for all lesions involving an avulsion of either the posterior band of the IGHL or posterior capsule from the humeral neck. The epidemiology of rHAGL lesion refers to patients with posterior instability, and its incidence is assessed to be much less common than that of HAGL lesions. Nonspecific shoulder complaints with a typical history of shoulder instability (dislocations or subluxations) are often present. The following provocative tests should be performed: apprehension test, the anterior and posterior load and shift test, and Kim or jerk test; however, there are no consistent, specific signs or symptoms to suggest an rHAGL. Magnetic resonance imaging (MRI) with or without intraarticular contrast remains the recommended imaging of choice in cases of suspected HAGL or rHAGL lesions. Conservative management is typically reserved for partial, intrasubstance lesions of the IGHL complex without any significant concomitant injuries. The surgical treatment of rHAGL lesion can be performed arthroscopically. The posterior capsule can only be fully visualized during diagnostic arthroscopy by using the anterolateral portal. Concomitant injuries are treated in every case. There are only few reports regarding this pathology including small case series; however, arthroscopic treatment of rHAGL lesion does not seem to be a technically demanding procedure and has shown to yield good clinical outcomes.