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Hill-Sachs Lesion – Causes, Symptoms & Treatment

A Hill-Sachs lesion is a bony indentation on the humeral head caused by a shoulder dislocation. It can contribute to ongoing shoulder instability and recurrent dislocations.

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Things worth knowing about "Hill-Sachs Lesion"

A Hill-Sachs lesion is a bony indentation on the humeral head caused by a shoulder dislocation. It can contribute to ongoing shoulder instability and recurrent dislocations.

What Is a Hill-Sachs Lesion?

A Hill-Sachs lesion (also called a Hill-Sachs defect or Hill-Sachs deformity) is a compression fracture on the posterior superior surface of the humeral head (the ball of the shoulder joint). It occurs when the humeral head forcefully impacts the anterior rim of the glenoid (shoulder socket) during an anterior shoulder dislocation. The lesion was first described in 1940 by American radiologists Harold Arthur Hill and Maurice David Sachs.

Causes and Mechanism

The primary cause of a Hill-Sachs lesion is an anterior glenohumeral dislocation, in which the humeral head slips forward out of the socket. As the softer bone of the humeral head collides with the harder anterior glenoid rim, a characteristic indentation is created.

Sports injuries (e.g., handball, volleyball, skiing, contact sports)
Falls onto an outstretched or abducted arm
Direct trauma to the shoulder
Repeated dislocations increase the size and depth of the lesion

Symptoms

Small Hill-Sachs lesions are often asymptomatic. Larger defects or those associated with shoulder instability may cause:

Shoulder pain, especially during overhead or rotational movements
A feeling of instability or catching in the shoulder (engagement)
Reduced range of motion
Recurrent dislocations or subluxations
Muscle weakness or atrophy in chronic cases

Diagnosis

Diagnosis is established through clinical examination combined with imaging studies:

X-ray: Specialized views (e.g., Stryker notch view, Didiee view) can reveal the bony indentation on the humeral head.
MRI (Magnetic Resonance Imaging): Provides detailed assessment of lesion size, depth, and associated soft tissue injuries such as Bankart lesions of the labrum.
CT (Computed Tomography): Best suited for precise bone analysis and preoperative planning.
Clinical tests: Instability tests such as the Apprehension test help evaluate the functional impact of the lesion.

Treatment

Conservative Treatment

Small, clinically insignificant Hill-Sachs lesions are typically managed non-surgically:

Physiotherapy to strengthen the shoulder-stabilizing muscles (especially the rotator cuff)
NSAIDs (non-steroidal anti-inflammatory drugs) for pain relief
Immobilization after acute dislocation followed by structured rehabilitation

Surgical Treatment

Large or engaging Hill-Sachs lesions -- those that catch on the anterior glenoid rim in certain shoulder positions -- usually require surgery:

Remplissage technique: The infraspinatus tendon is arthroscopically fixed into the bony defect to prevent engagement.
Latarjet procedure: A bone graft from the coracoid process is transferred to the anterior glenoid to compensate for bone loss and restore stability.
Allograft reconstruction: Donor bone material is used to fill very large defects.
Humeral head prosthesis: In severe chronic cases with extensive bone loss, joint replacement may be considered.

Prognosis and Outlook

The prognosis depends on the size of the defect and the number of prior dislocations. With timely and appropriate treatment, full restoration of shoulder function is achievable in many cases. Untreated large lesions increase the risk of recurrent dislocations and early-onset glenohumeral osteoarthritis.

References

Hill HA, Sachs MD. The grooved defect of the humeral head. Radiology. 1940;35(6):690–700.
Provencher MT, et al. The Hill-Sachs lesion: diagnosis, classification, and management. Journal of the American Academy of Orthopaedic Surgeons. 2012;20(4):242–252.
Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs. Arthroscopy. 2000;16(7):677–694.

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