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The Hill-Sachs lesion: diagnosis, classification, and management
Matthew T Provencher1, Rachel M Frank, Lance E Leclere
1Department of Orthopaedic Surgery, Naval Medical Center, San Diego, CA, USA.
Summary
Hill-Sachs lesions are common bone defects in the humeral head linked to shoulder instability. Identifying associated glenoid bone loss is crucial for effective treatment and optimal patient outcomes.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Radiology
Background:
- The Hill-Sachs lesion is a common osseous defect of the humeral head.
- It is strongly associated with anterior shoulder instability, particularly in recurrent cases.
- Reverse Hill-Sachs lesions are observed in posterior shoulder instability.
Purpose of the Study:
- To review the incidence and clinical significance of Hill-Sachs lesions.
- To emphasize the importance of identifying associated glenoid bone loss.
- To outline current diagnostic and treatment strategies for shoulder instability with bone defects.
Main Methods:
- Literature review of studies on Hill-Sachs lesions and shoulder instability.
- Analysis of radiographic and clinical findings associated with these injuries.
- Discussion of treatment algorithms based on lesion characteristics and instability patterns.
Main Results:
- Hill-Sachs lesions occur in nearly all patients with recurrent anterior shoulder instability.
- Glenoid bone loss frequently accompanies Hill-Sachs lesions and is critical for management.
- Accurate identification of all associated pathologies, including labral and capsular injuries, is essential.
Conclusions:
- Hill-Sachs lesions are a key indicator of shoulder instability, often part of a bipolar injury.
- Comprehensive evaluation including assessment of glenoid bone loss is vital for successful treatment.
- Treatment decisions are guided by clinical presentation, instability severity, and radiographic evidence, with options ranging from conservative rehabilitation to surgical intervention.
