Hill Sachs Lesion

Hill Sachs lesion

 An injury to the humeral head known as a Hill-Sachs lesion happens when the humerus is forcibly pulled away from the glenoid fossa, which features the shoulder joint.

When the humeral head strikes the glenoid fossa's edge during a traumatic dislocation of the shoulder joint, a defect in the posterolateral quadrant is caused.

Who are at risk?

Younger patients participating in high-impact activities, including athletes or military veterans, are more likely to develop the Hill-Sachs lesion. Additionally, it can happen in older people with shoulder joint degeneration or those who have a history of frequent shoulder dislocations.

Classification

According to the proportion of the humeral head that is affected, the severity of a Hill-Sachs lesion is classified, with larger lesions indicating a higher risk of shoulder instability and recurrent dislocations.

Depending on how much of the humeral head is affected, Hill-Sachs lesions are categorized. The severity of the injury can be determined using this classification system, which also directs possible treatments. The classification of Hill-Sachs lesions can be divided into three categories:

 Grade 1: This type of Hill-Sachs lesion affects less than 25% of the humeral head. In this type, defects can be found in the articular surface but do not affect the subchondral bone. It is considered a mild injury and is unlikely to cause significant instability of the shoulder joint. Conservative treatment, such as immobilization and physical therapy, is often sufficient for this type of injury.

Grade 2: Between 25% and 50% of the humeral head is affected by this particular type of Hill-Sachs lesion. In this type,  It is regarded as a moderate injury and could result in some shoulder joint instability. In addition to conservative measures like immobilization and physical therapy, this type of injury may also be treated surgically with an arthroscopic or open reduction and internal fixation.

Grade 3: More than 50% of the humeral head including a large aspect of subchondral bone is affected by this kind of Hill-Sachs lesion. It is regarded as a severe injury and may significantly increase shoulder joint instability. Surgery, including arthroscopic or open reduction and internal fixation, as well as potential bone grafting or remplissage procedures, are the usual course of action for this kind of injury.

There is a fourth classification scheme known as the "Bony Bankart Lesion Classification System" in addition to these three primary classifications. Injuries to the labrum of the shoulder joint, such as Bankart and Hill-Sachs lesions, are classified using this system. The Bony Bankart Lesion Classification System considers the size of the Bankart lesion as well as the size and location of the Hill-Sachs lesion, enabling a more thorough evaluation of the injury and directing treatment options.