Middle Glenohumeral Ligament

[David Smith]

I have colleagues who tell me that it is possible to locate the MGHL and IGHL on ultrasound, but I am not sure how to image these structures. I’m interested to hear some tips on this technique. Thanks.

[Steve Bird]

Hi David,
Glenohumeral ligament imaging with ultrasound is interesting.
They are capsular ligaments and we do have access to some parts of the capsule.
The SGHL is well seen in the rotator cuff interval deep to and medial to the long head of biceps tendon. This can be seen merging with the coracohumeral ligament to form the biceps sling.
The MGHL I have had no success with thus far but am keen to hear what others have experienced.
The IGHL can be seen by scanning in the armpit with the arm raised above the head. This inferior glen-numeral ligament view is nice as it becomes thick with synovitis or adhesive capsulitis. This view is also good for looking at OA changes in the humeral head cartilage.
I really feel we should be able to diagnose a Humeral avulsion of the inferior glenohumeral ligament (HAGL lesion) with ultrasound but I have not yet seen a case. I suspect this is due to the fact these patients go for MRI assessment which is always better for glenohumeral ligament assessment.
I have also been disappointed with the use of ultrasound for assessment of these ligaments with recurrent dislocatiors.
This is ultrasound, we have strengths and weaknesses. Embrace them all.
Steve.

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