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Shoulder News

New Classification for Rare But Serious Shoulder Injury

Humeral avulsion of the glenohumeral ligaments (HAGL) is a rare but serious cause of shoulder injury. Avulsion means the ligament is torn away from the bone. The result is repeated shoulder dislocation. This type of shoulder instability usually requires surgical repair.

In this article, surgeons present a new way to describe and classify HAGL lesions. They call it the West Point nomenclature. Nomenclature is another word for classification or groups.

Six patient case studies and a review of the current literature were used to develop the classification scheme. A total of 71 patients were included.

The HAGL lesion often occurs with other shoulder injuries. For example, the patient may have suffered a rotator cuff tear or a tear of the labrum (rim of cartilage around the shoulder socket). If it goes unrecognized and unrepaired, symptoms may persist even after surgery is done to reconstruct the shoulder.

The authors of this report give a thorough anatomical review of the glenohumeral ligaments. They also describe the many forms of HAGL injury. The goal is to improve clinical decision-making regarding treatment.

They found six separate forms of HAGL lesions. Damage to the anterior or posterior band of tissue was one of the distinguishing features. Two other forms involved a rupture of a tiny piece of bone along with the ligament and a tear of the labrum. Each of these additional injuries was given a name such as anterior bony HAGL, floating anterior inferior HAGL, or posterior bony HAGL.

The more specific the injury can be described, the more likely the right treatment can be applied. With accurate information, the surgeon can decide which is better for the patient: conservative care or surgical management. When surgery is required, the surgeon can use this method of classification to determine which repair is needed.


Liem T. Bui-Mansfield, MD, et al. Humeral Avulsion of the Glenohumeral Ligaments. The HAGL Lesion. In The American Journal of Sports Medicine. November 2007. Vol. 35. No. 11. Pp. 1960-1966.

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