Skeletal Radiology

, Volume 43, Issue 3, pp 307–313 | Cite as

Prevalence of HAGL lesions and associated abnormalities on shoulder MR examination

Scientific Article



Humeral avulsion of the glenohumeral ligament (HAGL) is an uncommon shoulder injury. We report the prevalence of HAGL lesions and other associated shoulder injuries in a large series of shoulder MR examinations. All results were correlated with surgery.

Materials and methods

MR reports of 1,000 consecutive conventional shoulder MR exams performed on patients with shoulder pain were reviewed in our information system for the word HAGL. A total of 743 patients went on to surgery. There were 23 HAGL lesions reported at surgery. Those 23 examinations were reviewed retrospectively in consensus by two musculoskeletal radiologists. Scans were assessed for HAGL lesions, full or partial thickness supraspinatus, infraspinatus or subscapularis tendon tears, superior labral anterior posterior (SLAP) tears, anterior or posterior labral tears, and Hill–Sachs lesions.


All 23 patients had HAGL lesions at surgery. Sixteen HAGL lesions were seen on prospective MR reading and 17 HAGL lesions were seen on retrospective MR consensus reading. Six HAGL lesions were not seen on retrospective consensus reading. Sixteen patients had Hill–Sachs deformities, ten had subscapularis tendon tears, five had supraspinatus tendon tears, six had superior labral tearing, and six had anterior labral tears. The above findings were confirmed on arthroscopy.


In this series, there was a 1.6 % prevalence on all MR examinations, and prevalence of 2.1 % seen on MR examination for those who went to surgery. Common injuries associated with HAGL lesions are Hill–Sachs deformities and subscapularis tendon tears. Anterior labral tears were seen in only six cases despite Hill–Sachs deformities in 16 patients. In patients with Hill–Sachs deformities without anterior labral tears, one must carefully assess for the presence of a HAGL lesion.


Shoulder MR Injury HAGL 


Conflict of interest

There are no conflicts of interest to report.


  1. 1.
    Bui-Mansfield L, Taylor D, Uhorchak J, et al. Humeral avulsions of the glenohumeral ligament: imaging features and a review of the literature. AJR. 2002;179:649–55.PubMedCrossRefGoogle Scholar
  2. 2.
    Wolf EM, Cheng JC, Dickson K. Humeral avulsion of glenohumeral ligaments as a cause of anterior shoulder instability. Arthroscopy. 1995;11:600–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Nicola T. Anterior dislocation of the shoulder: the role of the articular capsule. J Bone Joint Surg Am. 1942;25:614–6.Google Scholar
  4. 4.
    Bokor DJ, Conboy VB, Olson C. Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament a review of 41 cases. J Bone Joint Surg [Br]. 1999;81-B:93–6.CrossRefGoogle Scholar
  5. 5.
    Melvin J, MacKenzie J, Nacke E, et al. MRI of HAGL lesions: four arthroscopically confirmed cases of false-positive diagnosis. AJR. 2008;191:730–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Connell D, Padmanabhan R, Buchbinder R. Adhesive capsulitis: role of MR imaging in differential diagnosis. Eur Radiol. 2002;12(8):2100–6.PubMedGoogle Scholar
  7. 7.
    Murphy D, Koulouris G, Gopez A, et al. Humeral avulsion of the glenohumeral ligament. AJR. 2009;193:W74–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Bui-Mansfield L, Banks K, Taylor D. Humeral avulsion of the glenohumeral ligaments: the HAGL lesion. Am J Sports Med. 2007;35(11):1960–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Parameswaran A, Provencher M, Bach B, et al. Humeral avulsion of the glenohumeral ligament: injury pattern and arthroscopic repair technique. Sports Med Update. 2008;31:1–7.Google Scholar
  10. 10.
    Parameswaran A, Provencher M, Bach B, et al. Humeral avulsion of the glenohumeral ligament: injury pattern and arthroscopic repair techniques. Orthopedics. 2008;31(8):773–9.PubMedCrossRefGoogle Scholar
  11. 11.
    George M, Khazzam M, Kuhn J. Humeral avulsion of glenohumeral ligaments. J Am Acad Orthop Surg. 2011;19(3):127–33.PubMedGoogle Scholar
  12. 12.
    Field L, Boker D, Savoie F. Humeral and glenoid detachment of the anterior inferior glenohumeral ligament: a cause of anterior shoulder instability. J Should Elbow Surg. 1997;6(1):6–10.CrossRefGoogle Scholar

Copyright information

© ISS 2013

Authors and Affiliations

  1. 1.NSIMerritt IslandUSA
  2. 2.University of Central Florida School of MedicineOrlandoUSA

Personalised recommendations