From the Guidelines
A Hill-Sachs lesion is a significant finding in a relocated shoulder, indicating a previous dislocation and increasing the risk of recurrent instability, and its management should be guided by the lesion's size and location, as well as the presence of associated injuries such as Bankart lesions. This lesion is a compression fracture of the posterolateral humeral head that occurs when the shoulder dislocates anteriorly and the humeral head impacts against the anterior glenoid rim 1. The clinical importance of a Hill-Sachs lesion depends on its size and location, with small lesions (less than 20% of the articular surface) often being asymptomatic and not requiring specific treatment beyond standard rehabilitation for shoulder instability. However, larger lesions, especially those that are "engaging" (meaning they can catch on the glenoid rim during normal shoulder movement), significantly increase the risk of recurrent dislocations and may necessitate surgical intervention 1.
Some key points to consider in the management of Hill-Sachs lesions include:
- The use of imaging studies such as MRI or MR arthrography to assess the lesion and evaluate for associated injuries, particularly Bankart lesions (anterior labral tears) 1.
- The importance of a comprehensive rehabilitation program focusing on rotator cuff and periscapular strengthening to improve dynamic shoulder stability.
- The potential need for surgical intervention, including procedures such as remplissage, bone grafting, or humeral head replacement, in cases of large or engaging lesions.
- The use of specialized radiographic views, such as the Stryker notch view, to improve detection of Hill-Sachs deformities 1.
Overall, the presence of a Hill-Sachs lesion in a relocated shoulder should prompt a thorough evaluation and management plan to address the underlying instability and prevent recurrent dislocations.
From the Research
Significance of a Hill-Sachs Lesion
The Hill-Sachs lesion is a significant finding in the context of a relocated shoulder, particularly in cases of anterior shoulder instability.
- It is an osseous defect of the humeral head that occurs due to the humeral head impacting the anterior edge of the glenoid during dislocation 2.
- The incidence of Hill-Sachs lesions is high in patients with recurrent anterior shoulder instability, approaching 100% in some cases 2.
- The presence of a Hill-Sachs lesion can contribute to continued shoulder instability, especially if it is large and engaging 3.
- The treatment of a Hill-Sachs lesion depends on the size of the lesion, the presence of other associated injuries, and the degree of shoulder instability 2, 4.
Associated Injuries and Treatment
Hill-Sachs lesions are often associated with other injuries, such as:
- Bankart tears: a lesion of the anterior labrum of the glenoid 2, 5.
- Glenoid bone loss: a loss of bone from the anterior edge of the glenoid 2.
- Labral or capsular injuries: injuries to the labrum or capsule of the shoulder joint 2.
- Treatment options for Hill-Sachs lesions include nonsurgical management, such as focused rehabilitation, as well as surgical options, including arthroscopic and open techniques 2, 6.
Recurrence and Lesion Growth
The recurrence of anterior shoulder dislocations can increase the prevalence of Hill-Sachs and Bankart lesions 5.
- The proportion of Hill-Sachs lesions is significantly higher in complete dislocations compared to subluxations 5.
- Early surgical stabilization may be considered in cases where a Hill-Sachs or Bankart lesion is present after a first-time dislocation to limit lesion growth and prevent further instability 5.