HillSachs

Hill-Sachs lesion is a compression fracture of the posterolateral aspect of the humeral head resulting from an anterior dislocation of the glenohumeral joint. It occurs when the humeral head strikes the anteroinferior rim of the glenoid during dislocation, producing a cortical depression that can extend into the articular surface. The size and orientation of the lesion influence stability; larger defects may engage the glenoid rim during shoulder movements, contributing to recurrent instability, especially with anteroinferior labral injuries such as Bankart lesions.

Diagnosis and imaging commonly involve plain radiographs, but computed tomography provides precise quantification of bone loss, and magnetic resonance imaging can assess associated soft tissue injuries such as Bankart lesions or rotator cuff tears. The lesion’s morphology and its engagement with the glenoid during motion help guide treatment decisions.

Management depends on defect size, engagement, patient activity, and the presence of additional injuries. Small, non-engaging lesions may be managed nonoperatively after an initial dislocation with immobilization and structured rehabilitation. Engaging or large defects, or those with substantial glenoid bone loss, are more likely to require surgical intervention. Options include arthroscopic remplissage, which involves infraspinatus tendon tenodesis into the defect to prevent engagement; bone grafting or graft augmentation; and procedures addressing glenoid bone loss such as the Latarjet procedure. The choice of procedure is influenced by the extent of humeral head bone loss, persistent instability, and patient-specific factors.

Prognosis varies with defect size and timing of treatment. Hill-Sachs lesions contribute to recurrent instability when not adequately addressed, underscoring the importance of evaluating for associated injuries and tailoring management to the individual patient.