SHOULDER INSTABILITY
Hill-Sachs
Lesion
A Hill-Sachs lesion is one of the most common injuries that occurs during a shoulder dislocation. It is a dent or compression fracture in the ball of the shoulder that develops when the humeral head strikes the edge of the socket during the dislocation. Although many Hill-Sachs lesions never require specific treatment, larger lesions can contribute to recurrent shoulder instability and influence the type of surgery that is recommended.
Shoulder Dislocation
Back Of The Humeral Head
May Increase Instability
Depends On The Entire Shoulder
What Is A Hill-Sachs Lesion?
A Hill-Sachs lesion is a compression injury of the humeral head that occurs when the shoulder dislocates. As the ball comes out of the socket, it impacts against the front edge of the glenoid, creating a dent in the bone.
It is one of the most common findings after an anterior shoulder dislocation and often appears on MRI or CT scans obtained after the injury.
Dr. Streit's Clinical Perspective
A Hill-Sachs lesion is evidence that the shoulder has experienced enough force to damage the bone—not just the soft tissues. The important question is not whether a Hill-Sachs lesion exists, but whether it contributes to recurrent instability.
How Does It Happen?
When the shoulder dislocates anteriorly, the humeral head is forced against the front edge of the socket. That impact creates a small indentation in the bone. The larger the force—or the more times the shoulder dislocates—the larger the defect may become.
First-Time Dislocation
Many patients develop a small Hill-Sachs lesion during their first instability event.
Repeated Dislocations
Additional instability episodes may enlarge the defect over time.
High-Energy Trauma
More forceful injuries may produce larger compression defects.
Do All Hill-Sachs Lesions Cause Problems?
No.
Many Hill-Sachs lesions are small and never cause symptoms. Others become clinically important because they interact with bone loss on the socket side of the shoulder, making recurrent instability more likely.
What I Tell My Patients
"I don't treat the Hill-Sachs lesion by itself. I evaluate how it interacts with the rest of your shoulder. The combination of the labrum, ligaments, socket bone, and humeral head determines whether your shoulder is likely to remain stable."
How Is A Hill-Sachs Lesion Diagnosed?
History
Previous shoulder dislocation or instability.
Physical Examination
Assessment of shoulder stability and apprehension.
MRI
Often identifies the lesion and associated labral injury.
CT Scan
Provides the best assessment of bone loss and defect size when surgical planning is required.
Why Does A Hill-Sachs Lesion Matter?
May Increase Instability
Larger defects can contribute to recurrent dislocations.
Influences Surgical Planning
The size and location of the lesion help determine the most appropriate stabilization procedure.
Often Occurs With Other Injuries
Bankart tears and glenoid bone loss commonly accompany Hill-Sachs lesions.
Does Every Hill-Sachs Lesion Need Surgery?
No. Treatment is based on the entire instability pattern rather than the presence of the lesion alone. Some patients recover successfully with rehabilitation, while others benefit from arthroscopic stabilization, remplissage, a Latarjet procedure, or other procedures depending on the overall pattern of injury.
Dr. Streit's Treatment Philosophy
My goal is not simply to repair today's injury. It is to understand why the shoulder became unstable and select the procedure that provides the greatest chance of preventing future dislocations while preserving normal shoulder function.
Related Resources
Diagnosed With A Hill-Sachs Lesion?
A detailed shoulder evaluation can determine whether your Hill-Sachs lesion is simply a marker of a previous dislocation or an important contributor to recurrent instability that should influence treatment.
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