A Hill-Sachs lesion is an injury to the humeral head (the ball of the shoulder joint) that occurs when it impacts the edge of the glenoid (the socket) during a shoulder dislocation. This compression fracture or indentation in the posterior-lateral aspect of the humeral head is commonly associated with anterior shoulder dislocations and often accompanies a Bankart lesion.

Causes of a Hill-Sachs Lesion

1. Traumatic Shoulder Dislocation
   • The most common cause is anterior shoulder dislocation, where the humeral head is forced out of the socket and impacts the glenoid rim.
2. Recurrent Shoulder Dislocations
   • Repeated dislocations increase the severity of the lesion and the risk of complications.
3. Sports Injuries
   • High-impact or overhead sports (e.g., football, basketball, or volleyball) can lead to traumatic dislocations and subsequent Hill-Sachs lesions.
4. Accidents or Falls
   • A fall onto an outstretched arm or shoulder can cause dislocation and damage to the humeral head.
5. Underlying Instability
   • Individuals with ligamentous laxity or joint hypermobility are more prone to dislocations and associated lesions.

Symptoms of a Hill-Sachs Lesion

• Pain and discomfort in the shoulder, especially during motion.
• Recurrent episodes of instability or subluxation (partial dislocations).
• Difficulty performing overhead or rotational movements.
• Feeling of the shoulder “catching” or “locking.”
• Reduced range of motion and strength in the affected shoulder.

Treatment for a Hill-Sachs Lesion

Non-Surgical Treatment

For small or non-symptomatic lesions, conservative management is often sufficient:

1. Physical Therapy
   • Strengthening the rotator cuff and scapular stabilizing muscles to compensate for joint instability.
   • Improving range of motion and joint proprioception.
2. Activity Modification
   • Avoid activities that place stress on the shoulder or risk re-dislocation.
3. Pain Management
   • Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for pain and inflammation.
4. Immobilization
   • Temporary use of a sling after an initial dislocation to allow healing.

Surgical Treatment

Surgery is typically recommended for larger or symptomatic lesions or if instability persists despite conservative treatment.

1. Arthroscopic or Open Remplissage
   • A procedure where the defect in the humeral head is filled by attaching the infraspinatus tendon into the lesion.
   • This prevents the humeral head from engaging with the glenoid rim, reducing instability.
2. Capsular Tightening
   • Tightening the joint capsule to address underlying instability.
3. Bone Grafting
   • For extensive lesions, bone grafts (e.g., autografts or allografts) can be used to restore the contour of the humeral head.
4. Shoulder Replacement Surgery
   • In severe cases with advanced joint damage, a partial or total shoulder replacement may be required.
5. Latarjet Procedure
   • Addresses both the Hill-Sachs lesion and associated glenoid bone loss by transferring a piece of the coracoid process to the front of the glenoid.

Rehabilitation and Recovery

• Post-Surgery Rehab: Focuses on restoring range of motion, strength, and stability through a structured physical therapy program.
• Recovery Timeline: Full recovery may take 4–6 months, depending on the severity of the injury and the procedure performed.

Preventive Measures

• Strengthen shoulder muscles to stabilize the joint and reduce the risk of dislocation.
• Avoid positions or activities that predispose the shoulder to dislocation (e.g., extreme external rotation or abduction).
• Proper warm-up and stretching before physical activities.
• Manage any underlying conditions, such as ligamentous laxity or hypermobility, with targeted therapy.