Hill-Sachs Lesion: Signs, Causes & Treatment

A Hill-Sachs lesion is a traumatic compression fracture of the humeral head that occurs in the shoulder joint. First described in 1940 by American radiologists Harold Arthur Hill and Maurice David Sachs, this shoulder injury leaves an indentation in the bone and can cause pain and interfere with normal arm motion.

What You Need to Know About Hill-Sachs Lesion

• What Is a Hill-Sachs Lesion?
• What Causes a Hill-Sachs Lesion?
• Hill-Sachs Lesion Symptoms
• How Is a Hill-Sachs Lesion Diagnosed?
• Hill-Sachs Lesion Treatment

Introduction to Shoulder Injuries

Shoulder injuries are among the most common musculoskeletal problems, especially for people involved in sports or activities that require frequent overhead movements. The shoulder is a complex joint, and its wide range of motion makes it particularly vulnerable to injury.

One significant type of shoulder injury is the Hill-Sachs lesion, a compression fracture that develops on the posterolateral aspect of the humeral head, which is the rounded, ball-shaped part of the upper arm bone. This injury typically occurs when the humeral head is forcefully impacted against the anterior glenoid rim during an episode of anterior shoulder instability, such as a traumatic shoulder dislocation.

Understanding how these lesions form and the role they play in shoulder instability is crucial for effective diagnosis and treatment. By recognizing the signs and causes of Hill-Sachs lesions, patients and healthcare providers can work together to restore shoulder function and prevent further complications.

What Is a Hill-Sachs Lesion?

A Hill-Sachs lesion is a fracture of the humerus, the long bone of the arm that connects to the body at the shoulder. This condition often occurs due to a dislocated shoulder, when the arm bone slips out of the socket and is compressed against the socket’s rim. This abnormal position creates a bony defect, also referred to as an osseous defect, in the humeral head.

This defect, also known as a Hill-Sachs defect or humeral head defect, involves the articular surface of the humeral head, contributing to shoulder instability and pain.

Finding the best Hill-Sachs lesion treatment starts with a visit to Resurgens Orthopaedics. Schedule an appointment at one of our Metro Atlanta locations today.

What Causes a Hill-Sachs Lesion?

A Hill-Sachs lesion is most often caused by a shoulder dislocation. The shoulder consists of a ball-and-socket joint. When the ball slips out of the socket, it presses against the socket’s rim, leaving an indentation in the humeral head.

A Hill-Sachs lesion typically results from an anterior shoulder dislocation, also known as an anterior glenohumeral dislocation, when the humeral head impacts the anterior glenoid rim. Shoulder dislocations frequently occur as a result of contact sports, falls, accidents or repetitive overhead motion.

Hill-Sachs Lesion Symptoms

Common symptoms of a Hill-Sachs lesion include shoulder pain, decreased movement of the affected arm, popping, grinding or catching sensations and a reduced range of motion. Additionally, your shoulder may dislocate more easily.

How Is a Hill-Sachs Lesion Diagnosed?

To make a positive diagnosis, your Resurgens physician will perform a thorough physical examination and review your medical history, symptoms and the circumstances of the injury.

Diagnostic imaging will likely be ordered to assess possible damage to the bone, nerves and muscle. This may include X-ray, ultrasound, CT or MRI imaging. Imaging can also identify associated injuries such as Bankart lesions, which are injuries of the anterior glenoid labrum often seen with anterior shoulder dislocations, as well as reverse Hill-Sachs lesions, which are humeral head impaction fractures resulting from posterior shoulder dislocations.

Imaging helps determine the size of bony defects, distinguishing between small defects, typically less than 20% of the humeral head surface (which may be managed conservatively) and large lesions, such as extensive Hill-Sachs or reverse Hill-Sachs lesions, which may require surgical intervention.

This information is vital for planning your ideal treatment plan.

Complications of Hill-Sachs Lesions

If Hill-Sachs lesions are not properly addressed, they can lead to complications that affect the overall health and function of the shoulder joint. One of the most common issues is recurrent dislocation, where the shoulder continues to slip out of place due to the weakened structure of the humeral head.

This ongoing instability can strain the rotator cuff muscles and other soft tissues, increasing the risk of further injury. Over time, untreated Hill-Sachs lesions may contribute to chronic shoulder instability or osteoarthritis, as repeated stress damages the cartilage and bone within the joint. In more severe cases, surgical repair may be necessary to restore stability and function. Because of the increased risk of long-term problems, it is important to seek prompt medical attention and follow through with recommended treatment for any suspected Hill-Sachs lesion.

Hill-Sachs Lesion Treatment

Many Hill-Sachs lesions heal with rest, medication and physical therapy. Not all Hill-Sachs lesions require treatment, but those associated with glenohumeral instability or significant bone loss may require surgery to restore shoulder stability.

Surgical management decisions are influenced by the extent of glenoid bone loss and the involvement of soft tissue structures. If conservative methods do not yield suitable results, surgery may be indicated. Your Resurgens physician will tailor a treatment plan to your needs.

Non-Surgical Hill-Sachs Lesion Treatment

If your Hill-Sachs lesion affects less than 20% of the humeral head, your doctor may recommend physical therapy to strengthen the muscles that support the shoulder joint. Anti-inflammatory medication and avoiding activities that irritate the injury may also be recommended.

Surgical Hill-Sachs Lesion Treatment

If non-surgical treatments are not effective, your doctor may recommend surgery. Surgical options for large lesions or significant humeral head defects may include bone grafting or procedures such as remplissage, which involves transferring the infraspinatus tendon to fill the osseous defect.

There are several Hill-Sachs lesion surgery options ranging from minimally invasive procedures to restorative surgery. In cases of large humeral head defects or extensive osseous defects, bone grafting may be considered to restore joint stability. Postoperative rehabilitation protocols often include controlled external rotation to protect the repair and optimize healing. In extreme cases, your physician may recommend a total shoulder replacement.

Rehabilitation After Hill-Sachs Lesion

Rehabilitation is a key part of recovery following a Hill-Sachs lesion. A structured physical therapy program focuses on restoring strength, flexibility and stability to the shoulder joint. Exercises that target the rotator cuff muscles are especially important, as these muscles help support and stabilize the shoulder during movement.

Physical therapy may also include range-of-motion exercises, resistance training and functional activities tailored to the patient’s needs and activity level. The goal is to reduce pain, improve shoulder function and prevent future injuries or complications. Working closely with a physical therapist ensures that rehabilitation is safe, effective and adapted to the specific demands of each individual’s shoulder health.

Prevention of Hill-Sachs Lesions

Preventing Hill-Sachs lesions starts with protecting the shoulder from injury, particularly during sports or activities that involve repetitive overhead motions. Using proper technique and wearing protective gear, such as shoulder pads, can help reduce the risk of trauma.

Strengthening the rotator cuff muscles through regular exercise and physical therapy is also essential for maintaining shoulder stability and minimizing the likelihood of a lesion. Early recognition and treatment of shoulder injuries are crucial. If you experience pain, instability or other symptoms of a Hill-Sachs lesion, seeking prompt medical care can help prevent further damage and improve your chances of a full recovery.

By taking these proactive steps, individuals can help safeguard their shoulders and reduce the risk of developing Hill-Sachs lesions.

Schedule an appointment with a Resurgens Orthopaedics shoulder specialist today to get expert care and start your recovery.