We’ve talked about the basics of shoulder dislocation on this blog in the past, but every dislocation will cause varying degrees of damage to the shoulder joint and the surrounding structures, so they aren’t always treated in the same manner. One type of injury that is sometimes present in patients who have suffered a shoulder dislocation is the Hills-Sachs injury.
A Hills-Sachs injury occurs when a shoulder dislocation leads to the formation of a Hills-Sachs lesion or deformity to the head of the humerus bone. During a shoulder dislocation, the round humeral head on the top of your arm bone may end up striking the edge of the shoulder socket (the glenoid bone) with a significant amount of force. If this force is great enough, it can actually lead to a compression fracture in the humeral head that may be visible on an X-ray or MRI. In today’s blog, we take a closer look at these injuries and explain how Hill-Sachs defects are commonly treated.
The Hill-Sachs Shoulder Injury
Your ball and socket shoulder joint is made up of the humeral head and the glenoid bone, with a number of soft tissues helping to hold the ball within the socket. When too much force is applied to the shoulder area, the humeral head can pop out of the glenoid socket, pulling and tearing these supportive soft tissues in the process. You’ll have damage to the stabilizing ligaments and tendons in the area, but in a Hill-Sachs dislocation, you also have damage to the humeral head or the cartilage on the humerus.
If you visit your emergency department or a shoulder specialist and imaging tests reveal that a Hills-Sachs defect is present, this will confirm that a shoulder dislocation took place, even if your shoulder is back in its original position. In other words, not all shoulder dislocations result in Hill-Sachs defects, but all Hill-Sachs defects suggest that a complete shoulder dislocation occurred. But what does this mean for treatment?
In patients who suffer their first Hill-Sachs injury and dislocation, many need to have the shoulder joint repositioned in an emergency department or hospital. Imaging results will be able to determine the extent of the defect, which typically dictates treatment, although other factors like age, patient health and return to activity goals will also factor into the equation.
For patients with an Hill-Sachs injury that involves 20 percent or less of the humeral head, most patients can recover without the need for surgery. You will still pursue physical therapy and other conservative treatments to address the tissue damage that occurred during the dislocation, but you likely won’t need a surgical procedure to manage the Hill-Sachs defect. Hill-Sachs injuries that involve 20-40 percent of the humeral head will be managed on a case-by-case basis, while a defect that involves more than 40 percent of the humeral head almost always requires surgical intervention.
Some of the most common surgical treatments to address a Hill-Sachs defect include:
- Capsular Shift – This involves shifting the shoulder capsule to tighten nearby tissues to prevent excessive shoulder rotation. Limiting this rotation can help the defect heal so that it doesn’t impact humeral head movement within the glenoid.
- Bone Grafting – A large defect in the humeral head may need to be addressed with a bone graft to restore normal shape.
- Disimpaction – During a disimpaction procedure, the compressed humeral head bone is lifted so that when healing occurs, a more normal humeral head shape is restored.
- Shoulder Replacement – In rare instances where a severe defect is present, a shoulder replacement procedure may be recommended, but this is generally reserved for older patients.
When managed correctly, Hill-Sachs typically respond well to conservative or operative techniques. For more information about Hill-Sachs injuries or shoulder dislocations, reach out to Dr. Holloway and his team today at (865) 410-7887.
