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Capsular Lesions

Traumatic intra-substance injury of the joint capsule is commonly associated with anterior dislocation. Depending on the magnitude of the anterior shear force, either plastic deformation or a complete tear of the joint capsule can occur.

The recognition of a concomitant posttraumatic capsular laxity or rupture and a Bankart lesion is essential in order to select the correct surgical procedure. A traumatic capsular rupture or open rotator interval leads to venting of the joint, which increases glenohumeral translation. A positive sulcus sign in external rotation is the clinical sign for an open rotator interval.

Wolf et al.It described an intra-articular lesion associated with anterior instability where the glenohumeral ligaments are disruptive from the humerus and not the glenoid as in the case of a classic Bankart lesion. The authors coined the term a humeral avulsion of the glenohumeral ligaments, or HAGL lesion.

Although the entity appears to be rare, the authors concluded that the diagnosis must be kept in mind particularly in cases of traumatic anterior dislocations in the absence of Bankart lesions. Boker et al.It reported on the largest series (41 cases) so far in the literature of HAGL lesions in contact athletes.

The authors demonstrated that the surgeon must keep a high suspicion for a HAGL lesion in patients who have sustained a traumatic anterior dislocation and fail to have evidence of a Bankart lesion at arthroscopic examination. Although there is debate as to the best way to address the HAGL lesion, either open or arthroscopically, the current consensus appears to be that the lesion must be addressed in some way if surgical intervention is chosen.

Rarely, HAGL lesions may occur in conjunction with a Bankart lesion. Thus, appreciation of the humeral capsular insertion is important at the time of surgery. Tensioning of the capsule in the midrange can potentially overtighten and constrain the joint limiting rotation. In extreme cases, this can lead to posterior subluxation of the humeral head and arthritis.

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