Hill-Sachs Lesion

What is a Hill-Sachs lesion?

A Hill-Sachs lesion is a type of injury that affects your humerus (your upper arm bone). You might see it referred to as a Hill-Sachs defect. It’s caused when you experience a dislocated shoulder.

A Hill-Sachs lesion is like a dent in your bone. If you dislocate your shoulder and your humerus is pressed against the lip of its socket in your scapula (shoulder blade) the ball at the top of it can be damaged.

Most people recover from a dislocated shoulder that causes a Hill-Sachs lesion in a month or two with a few months of physical therapy.

Usually only severe Hill-Sachs lesions require surgery to repair.

Who is affected by Hill-Sachs lesions?

Because accidents like traumas or falls usually cause shoulder dislocations, anyone can dislocate their shoulder and develop a Hill-Sachs lesion.

Some groups of people are more likely to dislocate their shoulders, including:

• Athletes who play contact sports.
• People assigned male at birth (AMAB).
• People between 15 and 30 years old.
• Anyone who has previously dislocated their shoulder.

People assigned male at birth are more than two times more likely to dislocate a shoulder than people assigned female at birth (AFAB).

How common are Hill-Sachs lesions?

Only around 10 per 100,000 people in the U.S. dislocate a shoulder each year.

How does a Hill-Sachs lesion affect my body?

Usually, a Hill-Sachs legion itself won’t affect you any more than the dislocation that caused it. It might make your symptoms like pain feel more severe. It will be hard (or impossible) to move your arm right away after the injury. If you can move your arm or shoulder, it will probably be extremely painful and uncomfortable.

A Hill-Sachs lesion might make your injury take longer to recover. If you have a large Hill-Sachs lesion after your shoulder is dislocated, you may be more likely to experience another dislocation in the future.

People who have dislocated a shoulder are more likely to develop shoulder arthritis in that joint over time.

What are the symptoms of a Hill-Sachs lesion?

Hill-Sachs lesions usually have the same symptoms as the dislocated shoulder that causes them, including:

• Extreme pain.
• Weakness.
• Inability to move your arm.
• Your shoulder being visibly out of place.
• Swelling.
• Bruising or discoloration.
• Muscle spasms.
• Numbness, tingling or weakness in your arm, hand or fingers.

If you have a Hill-Sachs lesion, you might experience more severe versions of these symptoms.

Go to the emergency room right away if you have a dislocated shoulder or experience trauma.

What causes Hill-Sachs lesions?

Dislocated shoulders cause Hill-Sachs lesions.

Your shoulder is what’s known as a ball-and-socket joint. The head of your humerus (its top, near your shoulder) is shaped like a ball that fits into the socket in your scapula (you shoulder blade).

If your shoulder is dislocated forward (away from the front of your body), the rounded head at the top of your humerus can get pressed into the edge of the socket it’s usually in. This pressure can damage the head of your humerus enough to dent the ball.

The most common causes of dislocated shoulders include:

• Sports injuries.
• Falls.
• Car accidents.

How is a Hill-Sachs lesion diagnosed?

Your healthcare provider will diagnose a Hill-Sachs lesion while they’re examining your dislocated shoulder. They’ll physically examine your arm and shoulder, and will use imaging tests to take pictures of the damage inside your body, including:

• X-rays.
• MRI (magnetic resonance imaging).
• A CT (computed tomography) scan.

How are Hill-Sachs lesions treated?

Which treatment you’ll need for a Hill-Sachs lesion depends on how big it is. If the lesion is 20% or less of your humeral head, you’ll probably only need the usual treatment for a dislocated shoulder.

Closed reduction

The most important treatment for a dislocated shoulder is getting your arm back into its socket. This is called a closed reduction. During this non-surgical procedure, your provider will physically push and pull your body on the outside to set (align) your shoulder. They might give you a local anesthetic to numb the area around you shoulder or sedatives to relax your whole body.

Immobilization

After your closed reduction, you’ll need to wear a splint or sling to hold your injured shoulder in place. This is called immobilization. This will take stress off it and help it heal.

Your provider might recommend icing your injured shoulder a few times a day. You may need to do light exercises so your shoulder doesn’t tighten or freeze. Ask your provider how long you’ll need to wear the splint or sling, and how often you should exercise your shoulder. Most people need to immobilize their shoulder for a few weeks.

Physical therapy

As your shoulder heals, you’ll need to start physical therapy to help it regain its strength and ability to move. At first, you’ll probably only have stretches to loosen your shoulder and make sure it’s not too tight. Eventually, your provider or physical therapist will have you add in strength exercises to strengthen your muscles and ligaments. This will help reduce your risk of future dislocations. Most people need several months of physical therapy after a shoulder dislocation.

Hill-Sachs lesion surgery

If the Hill-Sachs lesion covers more than 20% of your humerus head, you might need surgery to repair it. The most common techniques include:

• Remplissage procedure: Your surgeon will fill the indent caused by the Hill-Sachs lesion with soft tissue that’s repaired (usually the capsule and tendon in your shoulder next to the injury).
• Bone grafting: Your surgeon will insert additional bone tissue to repair the damage to your humerus. This is sometimes called bone augmentation.
• Shoulder replacement: If there’s significant damage to your humerus, scapula and other tissue in your shoulder, you might need a shoulder replacement. Your surgeon will replace the damaged parts of your shoulder with prosthetic (artificial) pieces.

How long does it take to recover from a Hill-Sachs lesion?

It usually takes a few months to recover from a Hill-Sachs lesion. Your shoulder will be immobilized for a few weeks, and you’ll need months of physical therapy after that.

How long it takes your specific injury to heal depends on a few factors:

• What caused it.
• Any other injuries or damage inside your shoulder.
• Which treatments you needed, or if you needed surgery.

Your provider or surgeon will give you a specific recovery timeline for your injury.

How can I prevent a Hill-Sachs lesion?

Because accidents like falls or sports injuries typically cause dislocated shoulders, there’s not usually anything you can do to prevent a Hill-Sachs lesion.

Follow these general safety tips to reduce your risk of an injury:

• Always wear your seatbelt.
• Wear the right protective equipment for all activities and sports.
• Make sure your home and workspace are free from clutter that could trip you or others.
• Always use the proper tools or equipment at home to reach things. Never stand on chairs, tables or countertops.
• Use a cane or walker if you have difficulty walking or have an increased risk for falls.

What can I expect with a Hill-Sachs lesion?

Most people make a full recovery after their injury. Even if you need surgery, you should be able to return to most or all your activities and sports after your shoulder has healed.

You’re much more likely to re-injure a shoulder you’ve dislocated before. Some studies have found that more than 90% of athletes younger than 25 who dislocate a shoulder during a contact sport re-injure the same shoulder in the future.

Talk to your provider or surgeon before resuming any physical activities — especially contact sports. They’ll help you understand what to expect and how you can prevent future dislocations.

Will I need to miss work or school while I’m recovering from a Hill-Sachs lesion?

You might need to miss work or school while your shoulder is immobilized if you can’t do your job or schoolwork without moving your injured shoulder. Your provider will tell you which motions or positions to avoid while you’re recovering.

When should I go to the emergency room?

Go to the emergency room if you’ve experienced trauma.

If you think your shoulder is dislocated:

• Go to an emergency room or call 911 or your local emergency number.
• Don’t move your arm. Keep it close to your body.
• Don’t try to jam your shoulder back into place, and don’t let anyone other than a healthcare provider try to. If anyone other than an expert tries to put your shoulder back into place they can damage blood vessels, muscles, ligaments and nerves.
• Apply an ice pack to the injured area to reduce swelling and pain.
• Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) can help reduce your pain and other symptoms. Don’t take more than the recommended dose.

What questions should I ask my doctor?

• Will I need surgery to repair the Hill-Sachs lesion?
• How long will my arm need to be immobilized?
• When will I start physical therapy?
• When can I resume playing sports or working out?

What is the difference between a Hill-Sachs lesion and a reverse Hill-Sachs lesion?

Hill-Sachs lesions and reverse Hill-Sachs lesions are the same injury. The only difference is on which side of the ball of your humerus is damaged.

Hill-Sachs lesions are a dent in the back of the ball from your shoulder dislocating out of the front of its socket (the anterior side). Reverse Hill-Sachs lesions are a dent in the front of the ball of your humerus from your shoulder dislocating out of the back of its socket (the posterior side).

They’re diagnosed and treated the same way.

What is the difference between a Hill-Sachs lesion and a Bankart lesion?

Hill-Sachs lesions and Bankart lesions are both injuries related to dislocating your shoulder.

Hill-Sachs lesions are a dent in the bone on the head of your humerus when it’s pressed against the lip of its socket as you experience an anterior glenohumeral dislocation — the medical term for dislocating your shoulder forward and away from the front of your body.

Bankart lesions are injuries to your shoulder’s labrum (the protective bumper lining of the joint socket). They’re caused by shoulder dislocations or subluxations (partial dislocations). If you’ve dislocated your shoulder once, you have a much higher chance of dislocating it again in the future. The more you dislocate or subluxate your shoulder, the more you can damage your labrum (including a SLAP tear).

A note from Cleveland Clinic

Dislocating your shoulder can be a painful, scary injury. Suddenly not being able to move your arm (and knowing it’s out of its socket) is a shock. Don’t try to “pop” your shoulder back in. Go to the emergency room and get your injury treated by a healthcare provider as soon as possible.

If you’ve dislocated your shoulder once, you’ll have a higher risk of re-injuring it in the future — whether or not you had a Hill-Sachs lesion. Talk to your provider while you’re recovering. They’ll help you understand what to expect and how you can protect your shoulder.