Hill-Sachs lesion

A Hill-Sachs lesion is a dent or compression fracture in the ball of the shoulder joint that often develops after a shoulder dislocation. It can lead to ongoing shoulder instability and increase the chance of future dislocations. With an accurate diagnosis and the right treatment plan, most people regain shoulder stability and return to daily activities.

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A detailed view of shoulder muscles showing tendons and bones.

Anatomy of the shoulder

The shoulder is a ball and socket joint made up of the humeral head, the rounded top of the upper arm bone, and the glenoid, a shallow socket in the shoulder blade. This design allows the shoulder to move through a wide range of motion, but it also makes the joint more prone to dislocation than other joints in the body.

When the shoulder dislocates, the humeral head can forcefully hit against the edge of the glenoid socket. This impact can compress or fracture a section of the humeral head, creating a dent known as a Hill-Sachs lesion. Depending on its size and location, this defect can affect how well the ball of the joint stays seated in the socket, especially when combined with other soft tissue damage from the same dislocation.

Overview

Symptoms

A Hill-Sachs lesion doesn't always cause symptoms on its own, since it's often discovered after a shoulder dislocation. When symptoms do occur, they can include:

Shoulder pain, especially with certain arm positions
A feeling that the shoulder is loose, slipping or catching
Repeated shoulder dislocations or a sense of instability
Limited range of motion in the shoulder
Weakness when lifting or rotating the arm

Symptoms may become more noticeable over time if the shoulder continues to dislocate or feel unstable, since each episode can add further stress to the joint.

Causes

A Hill-Sachs lesion is caused by a shoulder dislocation, when the humeral head is forced out of the glenoid socket and strikes its bony edge. This impact compresses part of the humeral head, creating the characteristic dent.

Traumatic shoulder dislocations from a fall, collision or sports injury
Repeated shoulder dislocations, which can create a larger or deeper lesion over time
Dislocations that occur alongside other shoulder injuries, such as a Bankart lesion, which involves damage to the labrum, or cartilage rim, of the glenoid socket

The size and location of the lesion generally depend on how the dislocation happened and how many times the shoulder has been dislocated.

Risk factors

Certain factors can make a shoulder dislocation, and therefore a Hill-Sachs lesion, more likely. Having one or more of these factors doesn't mean the injury will happen.

Participation in contact sports or activities with a high risk of falls
A history of previous shoulder dislocations
Loose or naturally unstable shoulder ligaments
Younger age at the time of a first shoulder dislocation

Talking with an orthopedic specialist about your activity level and shoulder history can help you understand your personal risk.

Diagnosis

Diagnosing a Hill-Sachs lesion begins with a conversation about your injury history, including any past shoulder dislocations, followed by a physical examination to check shoulder stability and range of motion. Imaging tests, such as X-rays, CT scans or MRI scans, are typically used to confirm the lesion, measure its size and check for related injuries like a Bankart lesion. These details help your orthopedic specialist determine whether the lesion is considered on-track or off-track, which can guide treatment decisions.

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