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What’s the Diagnosis? is a means for you to test your orthopaedic, rheumatologic and radiology/imaging knowledge. Monthly, new cases will be presented as unknowns. The answers will be available and indexed so that should you want to search on cases representative of a specific topic, you can do so. The cases are from the records of HSS and the teaching files of the Department of Radiology and Imaging. The cases are intended to be representative and informative demonstrating the comprehensive care of Orthopaedics, Rheumatology, Radiology and Imaging and related services at HSS. We know you like to be challenged and hope this section meets your expectations.
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1What’s the Diagnosis – Case 51
2What’s the Diagnosis – Case 51
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Findings
CT and MRI images demonstrate an impaction of the posterolateral humeral head with an avulsion and medial displacement of the anteroinferior glenoid labrum. There has been a stripping of the scapular periosteum yielding a large amount of soft tissue edema. In addition, there is a small bone fragment avulsed from the anterior glenoid. The inferior glenohumeral ligament (IGHL) is otherwise intact. There is mild hyper intensity of the infraspinatus without a full thickness tear and no full thickness cartilage defect.
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Diagnosis: ALPSA
ALPSA or anterior labral periosteal sleeve avulsion is a Bankart variant or variant of an anteroinferior labral tear frequently seen in the setting of an anterior translational event (subluxation or dislocation). The ALPSA has a stripped but intact scapular periosteum allowing medial displacement of the labrum, which is important for the surgeon to be aware of preoperatively.
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Diagnosis: ALPSA
Specific mention was made of the intact IGHL to make clear the absence of a HAGL lesion (humeral avulsion of the glenohumeral ligament). This lesion to most necessitates the need for an open instead of arthroscopic repair. The posterolateral impaction represents a classic Hill Sachs lesion that when large may necessitate soft tissue or bony grafting. The small avulsion of the anterior glenoid represents a very small bony Bankart lesion. Again, when this lesion becomes large it may necessitate bony augmentation to help prevent recurrent subluxation/dislocation.
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Resources
• Stoller. MRI, Arthroscopy, and Surgical Anatomy of the Joints. 1999.
