From the Guidelines
Management of a Hill-Sachs deformity of the shoulder should prioritize humeral head resurfacing for patients with large Hill-Sachs deformity, as it is indicated in such cases to address the deformity and prevent further complications. When considering the management of Hill-Sachs deformity, it's crucial to assess the size of the deformity and the patient's symptoms. According to the study 1, humeral head resurfacing is indicated in patients with large Hill-Sachs deformity, suggesting that this approach can be beneficial for addressing the deformity. Key considerations in managing Hill-Sachs deformity include:
- The size of the deformity: Larger deformities may require more extensive surgical interventions.
- Patient symptoms: The presence of symptoms such as pain, decreased range of motion, and apprehension can guide treatment decisions.
- The "engaging" nature of the defect: Whether the defect catches on the anterior glenoid during shoulder movement, causing instability, is an important factor in determining the best course of treatment. In terms of specific treatment options, the study 1 highlights the importance of considering the patient's overall condition and the extent of the deformity when selecting a treatment approach. Some possible treatment options for Hill-Sachs deformity include:
- Conservative treatment with physical therapy for small, asymptomatic lesions.
- Arthroscopic procedures such as remplissage for moderate lesions causing instability.
- Humeral head bone grafting or arthroplasty for large defects. Post-surgical rehabilitation is also crucial, with a focus on protected range of motion and strengthening exercises to maintain shoulder function and mobility. Ultimately, the goal of treatment is to prevent recurrent dislocations while maintaining shoulder function and mobility, and the management approach should be guided by the individual patient's needs and circumstances.
From the Research
Management of Hill Sachs Deformity
The management of Hill Sachs deformity can be divided into non-surgical and surgical options.
- Non-surgical management, including focused rehabilitation, is acceptable in cases of small bony defects and nonengaging lesions in which the glenohumeral joint remains stable during desired activities 2.
- Conservative management with physical therapy for rotator cuff and periscapular strengthening can be attempted, with the addition of bracing if continued play is desired until the season's conclusion 3.
Surgical Options
Surgical intervention is considered in patients with recurrent dislocations, glenoid bone loss, or large Hill-Sachs lesions or in young athletes involved in contact or high-risk sports.
- Arthroscopic capsulolabral repair with at least 4 anchors if good tissue quality and no bone loss exist 3.
- Remplissage has been recommended by some surgeons if a large Hill-Sachs exists 3.
- Open repair is suggested in patients with a high number of recurrent dislocations without bone loss or in those who participate in high-risk sports 3.
- Coracoid transfer or the Latarjet procedure is suggested in patients with bone loss greater than 20% 3.
- Bone grafting for glenoid bone loss using autograft or allograft, such as distal tibial allograft, is recommended in patients with a failed Latarjet procedure or those with significant bone loss 3.
- Hill-Sachs lesion grafting may also be beneficial in those with large lesions that engage 3.
- A modified all-arthroscopic dynamic anterior stabilization (DAS) technique with added infraspinatus and posterior capsule remplissage to correct the extra-articular Hill-Sachs defect in a patient with recurrent dislocations and off-track bony lesions 4.
Diagnosis and Evaluation
Essential imaging includes radiography and magnetic resonance imaging in all patients, with 3-dimensional computed tomography being helpful to evaluate glenoid bone loss and Hill-Sachs lesions 3.
- Evaluation of the glenoid track is essential to help determine appropriate treatment because off-track scenarios in which the Hill-Sachs width is greater than the glenoid width impart a risk of failure with isolated arthroscopic treatment 3.
- Detection and quantification of clinically relevant humeral head bone loss are performed through an accurate history, physical examination, and interpretation of imaging studies 5.