A Hill-Sachs lesion can occur as a result of a traumatic shoulder dislocation. When the shoulder dislocates, the head of the humerus (ball of the upper arm bone) is forced out of its normal position and can make forceful contact with the edge of the glenoid (socket of the shoulder joint). This contact can damage the humeral head, leaving a “dent” in its normally rounded surface known as a Hill-Sachs lesion.
What Is a Hill-Sachs Lesion?
The head of the humerus (ball of the upper arm bone) is stabilized against the glenoid (socket of the shoulder joint) by a combination of muscles, labrum, and ligaments.
Most shoulder dislocations are anterior, meaning the humeral head moves forward from the body. During an anterior dislocation, forceful contact can occur between the posterior (back) side of the humeral head and the anterior (front) rim of the glenoid. This can leave a “dent” in the normally rounded surface of the humeral head known as a Hill-Sachs lesion.
In a posterior (backward) dislocation, contact occurs between the anterior portion of the humeral head and the posterior rim of the glenoid, resulting in a reverse Hill-Sachs lesion.
The presence of a Hill-Sachs lesion indicates that the patient has experienced at least one shoulder dislocation, even if other injuries are not as easily detected.
Causes and Risk Factors
Causes and risk factors associated with shoulder dislocation and Hill-Sachs lesions include:
- Direct blow to the shoulder or backward force on an extended arm or elbow
- Powerful or violent muscle contraction
- Repetitive throwing or swimming motion
- Participation in contact sports, such as football, wrestling, and basketball
- Activities involving forceful lifting, hitting, or twisting
- Previous shoulder dislocations or injuries
- Poor physical conditioning, including strength and flexibility
Symptoms
Signs and symptoms associated with shoulder dislocation may include:
- Severe shoulder pain at the time of dislocation
- Loss of function and pain with shoulder motion
- Feeling like the shoulder is going to “pop out”
- Occasional aching when not using the arm
- Tenderness and swelling
- Occasional loss of strength or difficulty raising the arm
- Occasional numbness and tingling in the arm after injury
Treatment
After the shoulder joint is reduced (put back into place) by trained medical personnel, treatment consists of ice, medications, and early mobilization. Whether or not surgery is performed, physical therapy exercises are necessary to restore motion and function to the recovering shoulder.
Hill-Sachs lesions rarely require treatment unless they are large and engage, or get stuck on the glenoid, within the normal ranges of shoulder motion. Engaging Hill-Sachs lesions may require repair with bone grafting or attaching the rotator cuff into the defect to prevent the Hill-Sachs lesion from engaging with the glenoid rim.
Dr. Chudik may recommend an arthroscopic procedure to address injuries that occurred with the shoulder dislocation.
Recovery and Outcomes
Conservative measures may be used to allow the shoulder to recover and increase muscular stability through exercises. However, the shoulder may remain unstable without surgical repair.
Following surgery, the shoulder is immobilized in a sling for six weeks to allow the repaired tissue to heal. Most patients experience full recovery and return to activities within four to six months after surgery.
Potential complications associated with shoulder dislocation and treatment include:
- Re-injury and repeated dislocations, particularly if not repaired
- Injury to nerves and blood vessels
- Bone fracture or cartilage injury with the dislocation or reduction process
- An unstable or arthritic shoulder following repeated injury
- Uncommon surgical complications, including infection, continued pain or re-injury, stiffness or loss of motion, post-traumatic arthritis, and inability to return to the previous level of competition or activity
When to See Dr. Chudik
For evaluation and treatment of a shoulder dislocation or Hill-Sachs lesion, call 630-324-0402, schedule an appointment online, or email contactus@chudikmd.com.