It takes a lot of force for your shoulder to dislocate out of its socket, so it should come as no surprise that surrounding tissues can be damaged as a result of the traumatic dislocation. While much of the attention is placed on the soft tissues that secure the humeral head in the glenoid socket, damage can also occur to the bony tissues in the shoulder. Sometimes the trauma to the shoulder is so severe that the humeral head actually becomes dented during the dislocation. This is known as a Hills Sachs lesion.
Hill Sachs lesions are a common occurrence in a traumatic shoulder dislocation, but how they are managed will be dependent on different factors. In today’s blog, we take a closer look at the management of Hills Sachs lesions after a shoulder dislocation.
Understanding Hills Sachs Lesions
As we mentioned above, a Hills Sachs lesion is formed during a dislocation injury when the humeral head is pressed against the lip of the shoulder socket. The forceful pressure of the dislocation can lead to the formation of a dent of a divot in the humeral head. The development of the lesion itself won’t affect you any more than the dislocation itself, so while you’ll still experience pain, limited range of motion, swelling and shoulder weakness, that will be tied to the whole of the injury and not the dent itself. It’s possible that your symptoms may feel a little more severe as a result of the trauma that led to the divot, but the dent itself isn’t going to be a major source of symptoms.
With that said, the formation of a dent on the humeral head could, along with damage to the rotator cuff and other soft tissues that hold the shoulder socket in place, put you at an increased risk for future dislocations. You’re going to want to proactively pursue treatment to strengthen the supportive soft tissues to help hold the humeral head in place. The dent isn’t going to heal, but it shouldn’t greatly increase your risk of additional dislocations so long as you aggressively pursue treatments that address injured supportive soft tissues. Your doctor can determine the shape and size of a Hills Sachs formation with the help of imaging techniques like an MRI or X-ray.
Treating Hills Sachs Lesions
Treating Hills Sachs lesions depend on the extent of the damage to the humeral head. The general consensus is that if the lesion extends to less than 20 percent of the humeral head, then no invasive management is needed for the lesion. Your focus will be on correcting the damage to the rotator cuff. Depending on the damage to these soft tissues, it’s still possible that a corrective surgical procedure may be warranted, but it’s unlikely that your provider will address the Hills Sachs lesion when it is relatively minor. If conservative approaches are recommended, you can expect a healthy dose of physical therapy and strengthening exercises, because again, the key is to stabilize the shoulder joint to regain function and reduce your likelihood of a subsequent dislocation.
In the event that the Hills Sachs lesion comprises more than 20 percent of the humeral head, your doctor will likely want to address it with surgical management. Surgery may already be necessary given the extent of the soft tissue damage that occurred during the dislocation, but the provider will also want to reform the humeral head to reduce your likelihood of future dislocations and general shoulder instability.
Your surgeon may opt to address the defect in different ways depending on its shape and location. A remplissage procedure fills the indent with soft tissue from the nearby infraspinatus tendon, or they may fill it using a bone graft in a bone augmentation procedure.
You can expect recovery to look similar regardless of whether or not your surgery to address a dislocated shoulder involved a Hills Sachs lesion repair. You’re going to immobilize the arm and shoulder for a few weeks before gradually working to expand range of motion and build strength with the help of a physical therapy routine. Your recovery will be measured in months, but most people are back to normal activities within 4-6 months, with full strength returning near the 6-month mark.
Contact Dr. Holloway
Dr. Holloway is confident that he can address whatever shoulder challenges you’re facing. For more information about Hills Sachs lesions, shoulder dislocations or a different shoulder concern, connect with Dr. Holloway and his team today at (865) 410-7887.
