title: Identification and management of chronic shoulder pain in the presence of an MRA-confirmed humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion.
abstract: OBJECTIVE
  To present the assessment and conservative management of chronic shoulder pain in the presence of a humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion in an active individual.
  
  
  METHODS
  A 47 year-old female office-worker with constant, deep, right shoulder pain with occasional clicking and catching claimed to have "tore something" in her right shoulder five years ago while performing reverse bicep curls. A physical exam led to differential diagnoses of a Superior Labrum Anterior to Posterior (SLAP) lesion, Bankart lesion, and bicipital tendinopathy. A Magnetic Resonance Arthrogram revealed a HAGL lesion.
  
  
  RESULTS
  A conservative chiropractic treatment plan in addition to physical therapy was initiated. The patient reported 75% improvement in symptoms after 4 treatments over a four-week duration.
  
  
  CONCLUSIONS
  This case demonstrates the successful implementation of a conservative plan of management suggesting that the treatment provided to this patient should be considered and attempted prior to arthroscopic surgery.
authors.affiliation: Elite Sport Performance, Calgary, Alberta; Resident of the Royal College of Chiropractic Sports Sciences (Canada).
authors.forename: Arif
authors.initials: A
authors.lastname: Karmali
authors.affiliation: Elite Sport Performance, Calgary, Alberta.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McLeod
keywords: HAGL; avulsion; chiropractic; glenohumeral; instability; ligament; shoulder pain; sports