The BHAGL lesion: a new variant of anterior shoulder instability

This article describes a new lesion associated with anterior instability of the shoulder. The bony humeral avulsion of the glenohumeral ligaments (BHAGL) is a rare lesion that may occur after anterior dislocation of the shoulder. There is a bone fragment noted on radiographs of the shoulder that may appear similar to a bony glenoid avulsion. Computed tomography typically will show that the bone is attached to the glenohumeral ligaments and does not originate from the glenoid. Arthroscopy may or may not show the lesion. This variant of anterior shoulder instability may present with impingement or instability symptoms. If symptoms fail to respond to conservative management, treatment through open excision of the bony fragment and reattachment of the glenohumeral ligaments to their origin on the anterior aspect of the humerus is indicated.