A shoulder that keeps slipping, catching, or dislocating despite previous treatment may have a Hill-Sachs lesion contributing to its instability. This bone defect on the humeral head is a common consequence of shoulder dislocations and, when significant, requires specific surgical management beyond a standard Bankart repair.
What is Hill-Sachs Lesion?
A Hill-Sachs lesion is a compression fracture or indentation on the posterolateral surface of the humeral head, created when the humeral head impacts the front edge of the glenoid during a shoulder dislocation. Each subsequent dislocation can deepen and enlarge the defect. When the Hill-Sachs lesion is large enough to engage with the glenoid rim during arm movement, it becomes what is termed an engaging or on-track lesion and significantly increases the risk of recurrent instability.
Types of Hill-Sachs Lesion
Causes
Hill-Sachs lesions are a direct consequence of anterior shoulder dislocation. The first dislocation creates the initial defect, and each recurrence deepens it. Patients with recurrent shoulder dislocations or those who have been living with untreated instability for a prolonged period are more likely to have significant Hill-Sachs lesions.
- Recurrent shoulder instability or apprehension in certain arm positions
- A sense that the shoulder catches or engages when the arm is placed in external rotation with the elbow at shoulder height
- Pain during specific movements that place the arm in a position where the lesion contacts the glenoid
- Functional limitation in overhead or throwing activities
Diagnosis
Plain X-rays can suggest a Hill-Sachs lesion. CT scan provides precise volumetric quantification of the lesion size and glenoid bone loss, which is essential for surgical planning. MRI assesses soft tissue injury including the labrum and rotator cuff.
Treatment
Remplissage with Bankart Repair
For engaging Hill-Sachs lesions in patients with limited glenoid bone loss, Dr. Kushalappa performs a remplissage procedure combined with arthroscopic Bankart repair. Remplissage involves anchoring the infraspinatus tendon into the Hill-Sachs defect, filling the bone cavity with soft tissue and preventing it from engaging with the glenoid during movement. This is performed entirely arthroscopically alongside the Bankart repair in the same session.
Open Latarjet Procedure
When significant glenoid bone loss accompanies the Hill-Sachs lesion, producing a bipolar bone deficiency, the Latarjet procedure is the preferred approach, reconstructing the glenoid side and providing robust stability.
Why Choose Dr. Kushalappa Subbiah in Bangalore?
Dr. Kushalappa Subbiah completed a Fellowship in Shoulder Surgery at the Sydney Shoulder Research Institute, where he trained in advanced arthroscopic shoulder procedures including labral repair and reconstruction. He holds the International Olympic Committee (IOC) Diploma in Sports Medicine, and has direct clinical experience managing shoulder injuries in Indian athletes across cricket, swimming, tennis, and contact sports. He is appointed as a Consultant Shoulder Surgeon at NH Hospital, Bangalore.