1. Hill-Sachs Lesion 1

2. Description
It is a compression fracture in the posterolateral head of the humerus. 2

3. Signs and Symptoms
Case study: Patient had pain on the lateral and posterior portions of his shoulder. Patient said it feels like a dull ache and the pain radiates to his elbow. He says it feels very weak and unstable. There was bruising and swelling around the humeral head. Patient was unable to do any AROM.
*Most important info for possible Hill-Sachs lesion is if they state that they had a shoulder dislocation. 3

4. Diagnosis
They do AP radiographs with the arm in internal rotation. If the compression is not very large then it may look like a vertical line from the top of the humeral head to the shaft. You also need to look at the glenoid rim closely in case of fractures on it. 4

5. Diagnosis Cont.
If it is not found on an x-ray then CT’s or MRI’s are very sensitive to the lesion which will look like a flattening or a wedge. 5

6. Normal Vs. Abnormal 6

7. Causes
Normally caused with an anterior shoulder dislocation when the humeral head hits against the glenoid cavity.
In the case study that I saw he also had a displaced glenoid fracture in the subacrominal space .
He dislocated his shoulder during a fall on the ice when the patient abducted and externally rotated the shoulder. 7

8. Management of patient
-With this patient we made him get an MRI to see if the rotator cuff or labrum had been torn.
-Patient ended up having a torn labrum that got scheduled for surgery.
-Until surgery patient was allowed Lortab and Ibuprofen for the pain and will be put in a sling as well. 8

9. Treatment Normally only requires treatment if it causes instability.
If the rotator cuff or labrum is injured then they will need to be repaired.
One procedure done is called a Connolly procedure and this is done if there is a large compression fracture.
They do a bone graft with soft tissue to fill the space. The use the infraspinatus with a bit of the greater tuberosity. This can be done arthroscopically. 9

10. Outcome of Case
-Patient had surgery on his rotator cuff and was in a sling for 5 weeks after that. He was prescribed to have therapy for 2 to 3x a week for 4 months after surgery.
-He did not need surgery on the Hill-Sachs lesion. 10

11. Possible Complications
-Rotator Cuff Tear
-Bankart Lesion of the glenoid: Detachment of the anterior inferior labrum from the glenoid.
-Large Hill-Sachs lesion that will need surgery.
-Fragments that are displaced. 11

12. References
"Hill–Sachs Lesion." Wikipedia. Wikimedia Foundation, 11 Apr Web. 19 Nov
Goel, Dr. Ayush, Galliard, Dr. Frank, et al. (2007). “Hill- Sachs Lesion.” Radiopaedia.org. 12