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Richard E. Debski - One of the best experts on this subject based on the ideXlab platform.
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anatomy and function of the Glenohumeral Ligaments in anterior shoulder instability
Clinical Orthopaedics and Related Research, 2002Co-Authors: Andreas Burkart, Richard E. DebskiAbstract:The anatomy of the Glenohumeral Ligaments has been shown to be complex and variable and their function is highly dependent on the position of the humerus with respect to the glenoid. The superior Glenohumeral ligament with the coracohumeral ligament was shown to be an important stabilizer in the inferior direction, even though the coracohumeral ligament is much more robust than the superior Glenohumeral ligament. The middle Glenohumeral ligament provides anterior stability at 45 degrees and 60 degrees abduction whereas the inferior Glenohumeral ligament complex is the most important stabilizer against anteroinferior shoulder dislocation. Therefore, this component of the capsule is the most frequently injured structure. An appropriate surgical procedure to repair the inferior Glenohumeral ligament complex after shoulder dislocation must be considered. In addition, a detached labrum can lead to recurrent anterior instability and a compromised inferior Glenohumeral ligament complex. However, additional capsular injury usually is necessary to allow anterior dislocation.
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Anatomy and function of the Glenohumeral Ligaments in anterior shoulder instability : Recent basic science and clinical advances in anterior Glenohumeral instability
Clinical Orthopaedics and Related Research, 2002Co-Authors: Andreas Burkart, Richard E. DebskiAbstract:The anatomy of the Glenohumeral Ligaments has been shown to be complex and variable and their function is highly dependent on the position of the humerus with respect to the glenoid. The superior Glenohumeral ligament with the coracohumeral ligament was shown to be an important stabilizer in the inferior direction, even though the coracohumeral ligament is much more robust than the superior Glenohumeral ligament. The middle Glenohumeral ligament provides anterior stability at 45° and 60° abduction whereas the inferior Glenohumeral ligament complex is the most important stabilizer against anteroinferior shoulder dislocation. Therefore, this component of the capsule is the most frequently injured structure. An appropriate surgical procedure to repair the inferior Glenohumeral ligament complex after shoulder dislocation must be considered. In addition, a detached labrum can lead to recurrent anterior instability and a compromised inferior Glenohumeral ligament complex. However, additional capsular injury usually is necessary to allow anterior dislocation.
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in situ force distribution in the Glenohumeral joint capsule during anterior posterior loading
Journal of Orthopaedic Research, 1999Co-Authors: Richard E. Debski, Eric K. Wong, Masataka Sakane, Freddie H Fu, Jon J.p. WarnerAbstract:Our objective was to examine the function of the Glenohumeral capsule and Ligaments during application of an anterior-posterior load by directly measuring the in situ force distribution in these structures as well as the compliance of the joint. We hypothesized that interaction between different regions of the capsule due to its continuous nature results in a complex force distribution throughout the Glenohumeral joint capsule. A robotic/universal force-moment sensor testing system was utilized to determine the force distribution in the Glenohumeral capsule and Ligaments of intact shoulder specimens and the joint kinematics resulting from the application of external loads at four abduction angles. Our results suggest that the Glenohumeral capsule carries no force when the humeral head is centered in the glenoid with the humerus in anatomic rotation. However, once an anterior-posterior load is applied to the joint, the Glenohumeral Ligaments carry force (during anterior loading, the superior Glenohumeral-coracohumeral Ligaments carried 26 ± 16 N at 0° and the anterior band of the inferior Glenohumeral ligament carried 30 ± 21 N at 90°). Therefore, the patient's ability to use the arm with the humerus in anatomic rotation should not be limited following repair procedures for shoulder instability because the repaired capsuloligamentous structures should not carry force during this motion. Separation of the capsule into its components revealed that forces are being transmitted between each region and that the Glenohumeral Ligaments do not act as traditional Ligaments that carry a pure tensile force along their length. The interrelationship of the Glenohumeral Ligaments forms the biomechanical basis for the capsular shift procedure. The compliance of the joint under our loading conditions indicates that the passive properties of the capsule provide little resistance to motion of the humerus during 10 mm of anterior or posterior translation with anatomic humeral rotation. Finally, this knowledge also enchances the understanding of arm positioning relative to the portion of the Glenohumeral capsule that limits translation during examination under anesthesia.
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An Analytical Approach to Determine the in Situ Forces in the Glenohumeral Ligaments
Journal of biomechanical engineering, 1999Co-Authors: Richard E. Debski, Eric K. Wong, S. L-y. Woo, Jon J.p. WarnerAbstract:The purpose of this study was to use an analytical approach to determine the forces in the Glenohumeral Ligaments during joint motion. Predictions from the analytical approach were validated by comparing them to experimental data. Using a geometric model, the lengths of the four Glenohumeral Ligaments were determined during anterior-posterior loading simulations and forward flexion-extension. The corresponding force in each structure was subsequently calculated based on length data via load-elongation curves obtained experimentally. During the anterior loading simulation at 0 deg of abduction, the superior Glenohumeral ligament carried up to 71 N at the maximally translated position. At 90 deg of abduction, the anterior band of the inferior Glenohumeral ligament had the highest force of 45 N during anterior loading. These results correlated well with those found in previous experimental studies. We believe that this validated analytical approach can be used to predict the forces in the Glenohumeral Ligaments during more complex joint motion as well as assist surgeons during shoulder repair procedures.
Jon J.p. Warner - One of the best experts on this subject based on the ideXlab platform.
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in situ force distribution in the Glenohumeral joint capsule during anterior posterior loading
Journal of Orthopaedic Research, 1999Co-Authors: Richard E. Debski, Eric K. Wong, Masataka Sakane, Freddie H Fu, Jon J.p. WarnerAbstract:Our objective was to examine the function of the Glenohumeral capsule and Ligaments during application of an anterior-posterior load by directly measuring the in situ force distribution in these structures as well as the compliance of the joint. We hypothesized that interaction between different regions of the capsule due to its continuous nature results in a complex force distribution throughout the Glenohumeral joint capsule. A robotic/universal force-moment sensor testing system was utilized to determine the force distribution in the Glenohumeral capsule and Ligaments of intact shoulder specimens and the joint kinematics resulting from the application of external loads at four abduction angles. Our results suggest that the Glenohumeral capsule carries no force when the humeral head is centered in the glenoid with the humerus in anatomic rotation. However, once an anterior-posterior load is applied to the joint, the Glenohumeral Ligaments carry force (during anterior loading, the superior Glenohumeral-coracohumeral Ligaments carried 26 ± 16 N at 0° and the anterior band of the inferior Glenohumeral ligament carried 30 ± 21 N at 90°). Therefore, the patient's ability to use the arm with the humerus in anatomic rotation should not be limited following repair procedures for shoulder instability because the repaired capsuloligamentous structures should not carry force during this motion. Separation of the capsule into its components revealed that forces are being transmitted between each region and that the Glenohumeral Ligaments do not act as traditional Ligaments that carry a pure tensile force along their length. The interrelationship of the Glenohumeral Ligaments forms the biomechanical basis for the capsular shift procedure. The compliance of the joint under our loading conditions indicates that the passive properties of the capsule provide little resistance to motion of the humerus during 10 mm of anterior or posterior translation with anatomic humeral rotation. Finally, this knowledge also enchances the understanding of arm positioning relative to the portion of the Glenohumeral capsule that limits translation during examination under anesthesia.
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An Analytical Approach to Determine the in Situ Forces in the Glenohumeral Ligaments
Journal of biomechanical engineering, 1999Co-Authors: Richard E. Debski, Eric K. Wong, S. L-y. Woo, Jon J.p. WarnerAbstract:The purpose of this study was to use an analytical approach to determine the forces in the Glenohumeral Ligaments during joint motion. Predictions from the analytical approach were validated by comparing them to experimental data. Using a geometric model, the lengths of the four Glenohumeral Ligaments were determined during anterior-posterior loading simulations and forward flexion-extension. The corresponding force in each structure was subsequently calculated based on length data via load-elongation curves obtained experimentally. During the anterior loading simulation at 0 deg of abduction, the superior Glenohumeral ligament carried up to 71 N at the maximally translated position. At 90 deg of abduction, the anterior band of the inferior Glenohumeral ligament had the highest force of 45 N during anterior loading. These results correlated well with those found in previous experimental studies. We believe that this validated analytical approach can be used to predict the forces in the Glenohumeral Ligaments during more complex joint motion as well as assist surgeons during shoulder repair procedures.
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effect of joint compression on inferior stability of the Glenohumeral joint
Journal of Shoulder and Elbow Surgery, 1999Co-Authors: Jon J.p. Warner, Mark K Bowen, Xianghua Deng, Peter A Torzilli, Russell F WarrenAbstract:Abstract To determine the relative importance of negative intraarticular pressure, capsular tension, and joint compression on inferior stability of the Glenohumeral joint we studied 17 fresh, normal adult cadaver shoulders using a “3 degrees of freedom” shoulder test apparatus. Translations were measured in intact and vented shoulders while a 50-N superior and inferior directed force was applied to the shoulder. Three different joint compressive loads (22 N, 111 N, 222 N) were applied externally. Tests were performed in 3 positions of humeral abduction in the scapular plane (0°, 45°, 90°) and in 3 positions of rotation (neutral, maximal internal, and maximal external). After tests of the intact and vented shoulder, the Glenohumeral Ligaments were sectioned and tests were repeated. With minimal joint compression of 22 N, negative intraarticular pressure and capsular tension limited translation of the humeral head on the glenoid. Increasing the joint compressive load to 111 N resulted in a reduction of mean inferior translation from 11.0 mm to 2.0 mm at 0° abduction, from 21.5 mm to 1.4 mm at 45° abduction, and from 4.5 mm to 1.2 mm at 90° abduction. With a compressive load of 111 N, venting the capsule or sectioning of Glenohumeral Ligaments had no effect on inferior stability. Clinical relevance: Glenohumeral joint compression through muscle contraction provides stability against inferior translation of the humeral head, and this effect is more important than negative intraarticular pressure or ligament tension.
Patrick N. Siparsky - One of the best experts on this subject based on the ideXlab platform.
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Understanding the Glenoid Avulsion of the Glenohumeral Ligaments as a Cause of Shoulder Instability: Surgical and Postsurgical Management
Arthroscopy techniques, 2019Co-Authors: Olivia C. O'reilly, Kyle Andrews, Patrick N. SiparskyAbstract:Abstract In adolescents and young adults, instability is a common shoulder pathology with a myriad of coexisting soft tissue and bony lesions. When evaluating a patient for the cause of instability, care must be given to assess for the infrequent lesions, including glenoid avulsion of the Glenohumeral Ligaments. This case example illustrates key points in the diagnosis, surgical, and postsurgical management of this less common cause of anterior shoulder instability.
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Glenoid Avulsion of the Glenohumeral Ligaments as a Cause of Recurrent Anterior Shoulder Instability
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation, 2010Co-Authors: Eugene M. Wolf, Patrick N. SiparskyAbstract:Although the Bankart lesion is accepted as the primary pathology responsible for recurrent shoulder instability, recognition of other soft-tissue lesions has improved the surgical treatment for this common problem. Whereas humeral avulsion of the Glenohumeral Ligaments has been acknowledged as a cause of anterior shoulder instability, we have not found any reported cases of glenoid avulsion of the Glenohumeral Ligaments. We describe 3 cases of recurrent anterior shoulder instability due to glenoid avulsion of the Glenohumeral Ligaments. The avulsed Ligaments were repaired to the labrum and glenoid, restoring the Glenohumeral ligament-labral complex.
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Case Report With Video Illustration Glenoid Avulsion of the Glenohumeral Ligaments as a Cause of Recurrent Anterior Shoulder Instability
2010Co-Authors: Eugene M. Wolf, Patrick N. SiparskyAbstract:Although the Bankart lesion is accepted as the primary pathology responsible for recurrent shoulder instability, recognition of other soft-tissue lesions has improved the surgical treatment for this common problem. Whereas humeral avulsion of the Glenohumeral Ligaments has been acknowl- edged as a cause of anterior shoulder instability, we have not found any reported cases of glenoid avulsion of the Glenohumeral Ligaments. We describe 3 cases of recurrent anterior shoulder instability due to glenoid avulsion of the Glenohumeral Ligaments. The avulsed Ligaments were repaired to the labrum and glenoid, restoring the Glenohumeral ligament-labral complex.
Nicole Pouliart - One of the best experts on this subject based on the ideXlab platform.
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Advanced imaging of the Glenohumeral Ligaments.
Seminars in musculoskeletal radiology, 2014Co-Authors: Nicole Pouliart, Michel De Maeseneer, Cedric Boulet, Maryam ShahabpourAbstract:The Glenohumeral Ligaments (GHLs) are the most important passive stabilizers of the shoulder joint. Recognition of acute and chronic Glenohumeral ligamentous lesions is very important in the preoperative work-up of shoulder instability and trauma. This article describes and depicts the normal anatomy of the GHLs and their appearance during arthroscopy and on MR and computed tomography arthrography (CTA). Pathologic findings of the superior, middle, and inferior GHLs are described and illustrated with MR and CTA and their corresponding intraoperative arthroscopic images. MR arthrography (MRA) is useful for direct visualization of all GHLs including most lesions of their intra-articular portion and associated capsulolabral pathologies. Sprains, midsubstance tears, avulsion, or fibrous infiltration of the GHL can be identified on MRA images using fast spin-echo sequences with and without fat saturation in the three planes. Although CTA is reputed to better depict associated bony and cartilage lesions, CTA allows only indirect evaluation of the GHLs by outlining their contour or showing contrast penetration. Normal variants may create pitfalls that one should be aware of. Signs of GHL pathology on imaging include: discontinuity, nonvisualization, changes in signal intensity (on MRA), contrast extravasation, contour irregularity, thickening, or waviness.
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musculoskeletal radiology radiologies musculo squelettique magnetic resonance arthrography of Glenohumeral lesions anatomy and arthroscopically confirmed pathology
2012Co-Authors: Cedric Boulet, Michel De Maeseneer, F Handelberg, Nicole Pouliart, Maryam ShahabpourAbstract:Interpretation of magnetic resonance (MR) arthrography images of the Glenohumeral Ligaments is made difficult by anatomical variations and by the lack of descriptions of signs of pathology of the Ligaments. In this review, we describe the normal and pathologic appearance of the Glenohumeral Ligaments of the shoulder. These Ligaments play an important role in stabilization of the shoulder. Both 1.5 and 3 T MR units were used to acquire the MR images. The principal investigator reviewed the imaging reports and arthroscopic reports. All cases were correlated with arthroscopy. Lesions of the superior Glenohumeral, middle Glenohumeral, and inferior Glenohumeral, including humeral avulsion of the glenoid ligament are discussed. Diagnosis of lesions of the Glenohumeral Ligaments remains a challenge.
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arthroscopic Glenohumeral folds and microscopic Glenohumeral Ligaments the fasciculus obliquus is the missing link
Journal of Shoulder and Elbow Surgery, 2008Co-Authors: Nicole Pouliart, Katia Somers, Olivier GageyAbstract:This study tested the hypotheses that the folds in the inferior Glenohumeral capsule appear at the borders and crossings of the underlying capsular Ligaments and that embalming may result in misinterpretation of these folds as Ligaments. The inferior capsular structures in 80 unembalmed cadaver shoulders were compared with 24 embalmed shoulders. During arthroscopy and dissection, an anteroinferior fold was more prominently seen in internal rotation and was almost obliterated in external rotation. A posteroinferior fold appeared in external rotation and almost disappeared in internal rotation. During dissection, the anteroinferior fold developed at the border of the anterior band of the inferior Glenohumeral ligament (ABIGHL) and where this ligament crossed with the fasciculus obliquus (FO). Several patterns of crossing of the ABIGHL and the FO were seen that determined the folding-unfolding mechanism of the anteroinferior fold and the appearance of possible synovial recesses. The axillary part of the IGHL is formed by the FO on the glenoid side and by the ABIGHL on the humeral side. The posteroinferior fold was determined by the posterior band of the IGHL. The folds in the embalmed specimens did not necessarily correspond with the underlying fibrous structure of the capsule. The folds and recesses observed during arthroscopy indicate the underlying capsular Ligaments but are not the Ligaments themselves. The IGHL complex is formed by its anterior and posterior bands and also by the FO. Both findings are important during shoulder instability procedures because the Ligaments need to be restored to their appropriate anatomy and tension. Because the FO may also be involved, Bankart-type surgery may have to reach far inferiorly. Midsubstance capsular shift procedures also need to incorporate this ligament.
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Simulated humeral avulsion of the Glenohumeral Ligaments: A new instability model
Journal of shoulder and elbow surgery, 2006Co-Authors: Nicole Pouliart, Olivier GageyAbstract:Humeral avulsion of the Glenohumeral Ligaments (HAGL) is an infrequent cause of shoulder instability. Experimental studies on this lesion are rare. This study was undertaken to determine the extent of humeral-based capsuloligamentous damage required for dislocation to occur. In 65 fresh cadaver shoulders, a humeral-sided ligamentous cutting sequence was done. After each step, degree of sulcus, translation, and instability were evaluated with an electromagnetic tracking device. There was a high degree of correlation between the amount of cut done and the resulting degree of instability. The order of the ligamentous cuts had no significant influence. For a dislocation to occur at least 3 zones had to be cut. Simulated HAGL can be used as a model for shoulder instability, although further experiments are needed to validate this model fully. Extensive capsuloligamentous lesions on the humeral side seem to be required before dislocation can occur. This may be a factor explaining the relative paucity of HAGL in clinical series.
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the arthroscopic view of the Glenohumeral Ligaments compared with anatomy fold or fact
Journal of Shoulder and Elbow Surgery, 2005Co-Authors: Nicole Pouliart, Olivier GageyAbstract:In a morphologic cadaveric study with observational arthroscopy in living subjects, we tried to resolve the contradiction in the literature with regard to the nature of the Glenohumeral Ligaments and the difference in observation of the folds during arthroscopic and open surgery. Observation of morphology and functional anatomy of the Glenohumeral capsule was performed in 200 non-embalmed cadavers through open dissection (100 specimens) and by arthroscopy (50 specimens) or both (50 specimens), as well as in 100 living subjects undergoing shoulder arthroscopy. In the resting arm position, folds and bands can be observed on the inside of the anteroinferior capsule. When the arm is moved into full abduction and external rotation, however, all bands progressively disappear from sight. The bands generally observed in the shoulder capsule during arthroscopy appear at the site of histologic reinforcements of the capsule but are not the capsular Ligaments themselves, as they seem to disappear in certain positions of the humerus. Arthroscopically, it is, therefore, not possible to discern the exact limits of these Ligaments. This may give rise to a certain amount of confusion when comparing clinical with anatomic and physiologic studies. On the other hand, their presence or absence in arthroscopic surgery might be of clinical relevance in evaluating capsular tension.
Olivier Gagey - One of the best experts on this subject based on the ideXlab platform.
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arthroscopic Glenohumeral folds and microscopic Glenohumeral Ligaments the fasciculus obliquus is the missing link
Journal of Shoulder and Elbow Surgery, 2008Co-Authors: Nicole Pouliart, Katia Somers, Olivier GageyAbstract:This study tested the hypotheses that the folds in the inferior Glenohumeral capsule appear at the borders and crossings of the underlying capsular Ligaments and that embalming may result in misinterpretation of these folds as Ligaments. The inferior capsular structures in 80 unembalmed cadaver shoulders were compared with 24 embalmed shoulders. During arthroscopy and dissection, an anteroinferior fold was more prominently seen in internal rotation and was almost obliterated in external rotation. A posteroinferior fold appeared in external rotation and almost disappeared in internal rotation. During dissection, the anteroinferior fold developed at the border of the anterior band of the inferior Glenohumeral ligament (ABIGHL) and where this ligament crossed with the fasciculus obliquus (FO). Several patterns of crossing of the ABIGHL and the FO were seen that determined the folding-unfolding mechanism of the anteroinferior fold and the appearance of possible synovial recesses. The axillary part of the IGHL is formed by the FO on the glenoid side and by the ABIGHL on the humeral side. The posteroinferior fold was determined by the posterior band of the IGHL. The folds in the embalmed specimens did not necessarily correspond with the underlying fibrous structure of the capsule. The folds and recesses observed during arthroscopy indicate the underlying capsular Ligaments but are not the Ligaments themselves. The IGHL complex is formed by its anterior and posterior bands and also by the FO. Both findings are important during shoulder instability procedures because the Ligaments need to be restored to their appropriate anatomy and tension. Because the FO may also be involved, Bankart-type surgery may have to reach far inferiorly. Midsubstance capsular shift procedures also need to incorporate this ligament.
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Simulated humeral avulsion of the Glenohumeral Ligaments: A new instability model
Journal of shoulder and elbow surgery, 2006Co-Authors: Nicole Pouliart, Olivier GageyAbstract:Humeral avulsion of the Glenohumeral Ligaments (HAGL) is an infrequent cause of shoulder instability. Experimental studies on this lesion are rare. This study was undertaken to determine the extent of humeral-based capsuloligamentous damage required for dislocation to occur. In 65 fresh cadaver shoulders, a humeral-sided ligamentous cutting sequence was done. After each step, degree of sulcus, translation, and instability were evaluated with an electromagnetic tracking device. There was a high degree of correlation between the amount of cut done and the resulting degree of instability. The order of the ligamentous cuts had no significant influence. For a dislocation to occur at least 3 zones had to be cut. Simulated HAGL can be used as a model for shoulder instability, although further experiments are needed to validate this model fully. Extensive capsuloligamentous lesions on the humeral side seem to be required before dislocation can occur. This may be a factor explaining the relative paucity of HAGL in clinical series.
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the arthroscopic view of the Glenohumeral Ligaments compared with anatomy fold or fact
Journal of Shoulder and Elbow Surgery, 2005Co-Authors: Nicole Pouliart, Olivier GageyAbstract:In a morphologic cadaveric study with observational arthroscopy in living subjects, we tried to resolve the contradiction in the literature with regard to the nature of the Glenohumeral Ligaments and the difference in observation of the folds during arthroscopic and open surgery. Observation of morphology and functional anatomy of the Glenohumeral capsule was performed in 200 non-embalmed cadavers through open dissection (100 specimens) and by arthroscopy (50 specimens) or both (50 specimens), as well as in 100 living subjects undergoing shoulder arthroscopy. In the resting arm position, folds and bands can be observed on the inside of the anteroinferior capsule. When the arm is moved into full abduction and external rotation, however, all bands progressively disappear from sight. The bands generally observed in the shoulder capsule during arthroscopy appear at the site of histologic reinforcements of the capsule but are not the capsular Ligaments themselves, as they seem to disappear in certain positions of the humerus. Arthroscopically, it is, therefore, not possible to discern the exact limits of these Ligaments. This may give rise to a certain amount of confusion when comparing clinical with anatomic and physiologic studies. On the other hand, their presence or absence in arthroscopic surgery might be of clinical relevance in evaluating capsular tension.
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Reconciling Arthroscopic and Anatomic Morphology of the Humeral Insertion of the Inferior Glenohumeral Ligament
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the Internation, 2005Co-Authors: Nicole Pouliart, Olivier GageyAbstract:Purpose: To clarify the morphology of the humeral insertion of the inferior Glenohumeral ligament (IGHL). Type of Study: Cadaveric and arthroscopic anatomic analysis. Methods: The morphology of the humeral insertion was studied in 200 nonembalmed cadavers through open dissection (100 specimens), by arthroscopy (50 specimens), or both (50 specimens). In addition, the morphology was studied in 100 living subjects with stable shoulders undergoing shoulder arthroscopy. Results: On the humeral side, the insertion of the inferior capsular fibers is usually in the form of a V, the point of which is covered by the tendon of the latissimus dorsi. When viewed intra-articularly, the inferior insertion usually gives a collar-like impression because the capsular recess is filled with frenula capsulae. Conclusions: Our description corresponds with that found in the classic literature. Our results are, however, in contrast with those of others who have observed about 50% of V-shaped insertions. This difference may be explained by the method of observation and by the small numbers of specimens studied. The form of the humeral insertion of the IGHL is linked to the formation of a supporting hammock that can accommodate the humeral head during movement as described by several authors. Clinical Relevance: We believe that the difference between arthroscopic and anatomic observation of the humeral insertion may have 2 major clinical implications. An observed tear of the frenula capsulae may not necessarily represent a humeral avulsion of the Glenohumeral Ligaments (HAGL). In the case of a HAGL, the capsule may have to be reattached in its V-form to adequately retension the inferior capsule.
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O1253 EXPERIMENTAL STUDY OF HUMERAL AVULSION OF THE Glenohumeral Ligaments. CONSEQUENCES FOR SHOULDER STABILITY
2004Co-Authors: Nicole Pouliart, Olivier GageyAbstract:Aim: To study the contribution of humeral avulsion of the Glenohumeral Ligaments (HAGL) to shoulder instability. Methods: In fourteen fresh cadaver shoulders a selective cutting sequence was performed. After each section an abduction-external rotation manoeuvre with axial compression and translation was carried out to provoke dislocation. The resulting instability was graded on a scale of five, ranging from no translation to a locked dislocation. Results: Cutting of only the inferior Glenohumeral ligament complex resulted at the most in increased translation, but not in subluxation. For subluxation to occur, at least the middle Glenohumeral ligament needed to be cut. The entire humeral capsuloligamentous complex needed to be sectioned before subluxation or dislocation occurred. In half of the cases an additional lesion of the subscapularis or the latissimus dorsi is necessary to allow a locked antero-inferior dislocation. Conclusion: Extensive damage to the humeral side of the capsulo-ligamentous complex and, frequently, associated lesions of the subscapularis or latissimus dorsi muscles are necessary to allow dislocation. This might be the primary reason for the low incidence of HAGL observed in clinical series of shoulder instability