HillSachslesion

A Hill-Sachs lesion, also known as a Hill-Sachs defect, is an impression fracture of the posterolateral aspect of the humeral head resulting from an anterior dislocation of the glenohumeral joint. The injury occurs when the humeral head drives against the anterior glenoid rim during dislocation, producing a cortical dent that can range from small to large. The lesion may be solitary or accompany other injuries such as a Bankart lesion (detachment of the anteroinferior labrum) and glenoid bone loss, and it contributes to shoulder instability in some patients.

Pathophysiology and clinical significance center on whether the defect engages the glenoid during movement. Lesions are sometimes described as on-track or off-track, with off-track defects more likely to engage the rim and promote recurrent dislocations or instability after initial injury or repair.

Diagnosis typically involves radiographs (standard shoulder views, including axillary views when feasible) and is often clarified with cross-sectional imaging. Computed tomography provides precise measurements of defect size and orientation, while magnetic resonance imaging can assess associated soft tissue injuries such as a Bankart lesion and rotator cuff or labral pathology.

Management decisions depend on defect size, clinical history, and instability risk. A small, non-engaging Hill-Sachs lesion may be managed conservatively after a first dislocation. Recurrent instability or engaging lesions may require surgical options such as remplissage (soft-tissue tenodesis of the infraspinatus into the defect), osteochondral grafting, or procedures addressing glenoid bone loss, such as the Latarjet procedure. The choice depends on the lesion’s size, the glenoid track, and patient activity goals. Prognosis varies with defect size and associated injuries.