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Hill Sachs Lesion

A Hill Sachs Lesion or Hill Sachs Fracture is a dent or a compression injury to the posterolateral part of the humeral head created by the glenoid rim during dislocation. It occurs when the humeral bone pops out of the socket, its relatively soft head impacts against the anterior edge of the glenoid.

Shoulder can dislocate forward, backward or downward. A Hill-Sachs injury occurs only when there is a forward dislocation of the shoulder.

Hill Sachs Lesion is named after two American radiologists Harold Hill and Maurice Sachs – who in 1940, popularized the injury, provided radiographic evidence and determined a link between the lesion and recurrent instability.

Hill Sachs Lesion

Symptoms

Symptoms of a Hill sachs dislocation include:
Severe pain
Difficulty moving the joint
Visible deformation of the shoulder sometimes with a bulge in the front of the joint
Swelling or inflammation
Nausea and Weakness

Causes

The Hill Sachs lesion is typically caused by a shoulder dislocation.
Sudden falls
Sports injuries
Trauma like car accidents

Diagnosis

Your shoulder specialist will diagnose a Hill-Sachs Lesion using one or more of the following methods:

  • Physical examination
  • X-rays
  • Ultrasound
  • MRI

Treatment

The bony defect itself does not require treatment, but the associated injuries and continuous symptoms and instability requires treatment. Shoulder dislocations don’t occur isolated, it causes damage to other tissues surrounding the glenohumeral joint like the ligaments, tendons and the joint capsule.
Treatment depends on the extent of injury, the size of the lesion, its placement etc. Small injuries, where less than 20% of humeral head is involved, can be left alone with some physiotherapy.
Larger lesions which involves 20-40% of the humeral head and is contributing to instability require arthroscopic surgery. Such lesions generally damage other tissues like labrum, rotator cuff, anterior capsule etc. Surgery is very successful in preventing repeat dislocations and restoring motion.
The biggest concern post a Hill Sachs injury is the redislocation rate. More redislocations occur in teenagers than in older people as teenagers have higher percentage of loose tissue.
Treatment options include:
Capsular Shift- is done to tighten up the soft tissues
Remplissage – is primarily a tissue filling process

Disimpaction – this is a relatively new procedure which is still being explored

Shoulder Replacement or Shoulder Resurfacing  - some cases of Hill sachs lesion can only be treated with a Shoulder Replacement or Shoulder Resurfacing

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