Let's learn exactly about the Hill-Sachs Lesion that occurs when the shoulder is dislocated!

You've probably heard someone say they dislocated their shoulder, can't lift their arm, and are in excruciating pain, right? Maybe that's what happened to you too. When a shoulder dislocates, meaning the ball-like part of the shoulder comes off, the bones inside our shoulder can also be damaged. That's what this `Hill-Sachs Lesion` (also called a Hill-Sachs lesion) is. Let's talk about this simply and clearly.

What is this `Hill-Sachs Lesion`?

Simply put, a Hill-Sachs Lesion is a small bump or bruise that occurs on the top of your upper arm bone (the long bone at the top of the arm that connects to the shoulder - the humerus), specifically on the ball-like part of it (the humeral head). Imagine that when you drop your shoulder, this ball-like part rubs hard against the socket of your shoulder joint (the glenoid socket). That's when a small piece of this bone is crushed and forms a small dent. It's like a small bruise when an apple falls to the ground.

Who is more likely to develop this `Hill-Sachs Lesion`?

In fact, anyone who can dislocate their shoulder is at risk of developing this `Hill-Sachs Lesion`. This is because it occurs when the shoulder is dislocated in an accident or fall. However, for some people, this risk is a little higher.

• For athletes: Especially those who play contact sports, for example rugby, football, boxing.
• For men: It is said that men are more than twice as likely to have a shoulder dislocation than women.
• For young people between the ages of 15 and 30: People in this age group are more likely to be involved in accidents because they are very active.
• For those who have dislocated their shoulder before: Once you dislocate your shoulder, you are more likely to dislocate it again. This can lead to a `Hill-Sachs Lesion`.

How common is this condition?

According to American data, about 10 people per hundred thousand dislocate their shoulder each year. That means it doesn't happen to everyone. However, if you dislocate your shoulder, the likelihood of developing a `Hill-Sachs Lesion` is significant. Some studies suggest that between 40% and 90% of people who dislocate their shoulder will develop this injury. That means if you dislocate your shoulder, you have to think about this too.

How does this `Hill-Sachs Lesion` affect your body?

Most of the time, a `Hill-Sachs Lesion` alone does not have a significant impact. That is, the pain from the shoulder dislocation and the inability to move the arm are the main symptoms. However, if this `Hill-Sachs Lesion` is present, those symptoms may be a little more severe . The pain may be worse, and the difficulty in moving the arm may increase.

Another thing is that this `Hill-Sachs Lesion` may take a little longer for your shoulder to heal. Also, if this bruise (`lesion`) is large, the chance of re-dislocation of the shoulder in the future is also high. Over time, there is a possibility of `shoulder arthritis` developing in that shoulder joint, which means a condition where the joint wears out.

What are the symptoms of a Hill-Sachs Lesion?

The symptoms of a `Hill-Sachs Lesion` are essentially the same as those of a dislocated shoulder. However, as I mentioned before, if you have this `lesion`, the symptoms may be a little more severe.

• Feeling very severe pain .
• I feel weakness in my hand.
• I can't move my hand.
• The shoulder looks different , without where it used to be (as if it had popped out).
• Swelling occurs.
• You may see bruises or changes in skin color.
• Muscle spasms .
• You may feel numbness, tingling, or weakness in your hand, palm, or fingers.

Important: If you think you have dislocated your shoulder, or if you have had a serious accident to your shoulder, go to the nearest hospital emergency room immediately. Don't delay, as it is very important to get treatment quickly.

What causes this `Hill-Sachs Lesion`?

The main cause is shoulder dislocation .

Think of it this way: our shoulder joint is a `ball-and-socket joint`. The ball-like part on top of your upper arm bone (`Humerus`) is normally inside the `socket` on the shoulder bone (`Scapula`).

Now, if your shoulder pops forward (that is, out from the front of your body), the ball-like part of the upper arm bone, the socket, can get stuck in the socket and rub. That pressure causes the ball-like part to become bruised and form a `dent`. This is called a `Hill-Sachs Lesion`.

The main reasons for shoulder shrugs are:

• Sports injuries - Think of falling while playing rugby, or diving while playing cricket.
• Falls - This can happen just by falling to the ground or down stairs.
• Car accidents - These types of accidents can also cause shoulder injuries.

How do doctors recognize a `Hill-Sachs Lesion`?

When you go to a doctor with a dislocated shoulder, they will check for a Hill-Sachs Lesion when they examine you.

First, the doctor will do a physical examination of your arm and shoulder. They will look for areas of pain, swelling, and whether you can move your arm. Then, they may do some imaging tests to see exactly what's going on inside.

They are:

• X -rays: These can help to check for bone alignment, fractures, and other conditions. A Hill-Sachs lesion can sometimes be seen on an X-ray.
• An MRI (Magnetic Resonance Imaging) scan: This can provide a very clear view of the soft tissues, such as muscles, ligaments, tendons, and bones. An MRI is very important to determine the exact size and depth of a Hill-Sachs Lesion.
• A CT (Computed Tomography) scan: This can also provide very detailed information about the bones. A CT scan is sometimes used when planning surgery.

These scans can clearly see the location and size of the bone bruise, which is a great help in planning treatment.

How is a Hill-Sachs Lesion treated?

The type of treatment you need depends on the extent of the Hill-Sachs Lesion, that is, the damage to the bone.

Typically, if less than 20% of the humeral head is broken, no special treatment is needed. The usual treatment for a dislocated shoulder is used.

Non-surgical treatments

1. Closed reduction:

This is the most important thing. It means putting your shoulder back where it was, in the socket. This is not surgery. The doctor will hold your shoulder from the outside, pull it in the right direction, and push it back in. While doing this, you may be given a local anesthetic (a medicine that numbs only the area) to reduce pain, or you may be given some sedatives (medicines that make you feel a little calmer).

2. Immobilization:

After the shoulder is put back in place, you may need to wear a splint or sling to keep it in place. This is called immobilization. This allows the injured shoulder to rest and help it heal.

The doctor may tell you to apply ice several times a day. He or she may also tell you to do some exercises to keep your shoulder from getting stiff or frozen (freezing). Ask your doctor how long you should wear the sling and how much exercise you should do. Most people need to keep their shoulder immobilized for a few weeks.

3. Physical therapy:

As your shoulder gradually heals, you will need to start physical therapy to regain strength and mobility . The first step is to do some simple stretches to keep your shoulder loose and free from stiffness. Then, your doctor or physical therapist will add strength exercises to strengthen your muscles and ligaments. This will also help to reduce the risk of future dislocations. Many people will need to do physical therapy for several months after a dislocation.

Surgery for Hill-Sachs Lesion

If the `Hill-Sachs Lesion`, that is, the bone bruise, covers more than 20% of the ball-like part of the upper arm bone (the `humerus head`), meaning the bruise is large, surgery may be required to repair it.

There are several commonly performed surgical procedures:

• Remplissage procedure: This involves filling the pit-like space left by a Hill-Sachs lesion with nearby soft tissue. Typically, the capsule and tendon near the shoulder injury are used for this.
• Bone grafting: In this procedure, the doctor takes extra bone tissue and transplants it into the damaged area of ​​the humerus to repair it. This is sometimes called bone augmentation.
• Shoulder replacement: If there is significant damage to the humerus, scapula (shoulder blade), and other tissues in the shoulder, a shoulder replacement may be necessary. In this case, the surgeon removes the damaged parts of the shoulder and replaces them with prosthetic pieces.

How long does it take to heal?

It usually takes several months to recover from a Hill-Sachs Lesion. Your shoulder will need to be immobilized for several weeks, followed by months of physical therapy.

How long it takes for your wound to heal depends on several factors:

• How the injury occurred (such as a fall or a sports accident).
• Whether there are other injuries or damage inside the shoulder (such as torn ligaments or damage to the labrum).
• What kind of treatment did you need, or if you had to have surgery ?

Your doctor or surgeon will give you a specific recovery time for your injury, so don't worry.

Can this `Hill-Sachs Lesion` be prevented?

Since most shoulder dislocations are caused by sudden events such as falls and sports accidents, there is really nothing that can be done specifically to prevent this `Hill-Sachs Lesion`.

However, it's a good idea to follow these general safety tips to reduce the risk of accidents:

• Always wear a seat belt when riding in a vehicle.
• Wear appropriate safety equipment (e.g. helmet, shoulder pads) during any activity and sport.
• Keep your home and workplace tidy and free of items that could cause you or others to fall. Be aware of slippery surfaces.
• When picking up something from above, always use a tool or appliance that is specifically designed for the purpose. Never climb on chairs or tables.
• If you have difficulty walking or are at high risk of falling, use a cane or walker.

What to expect with a `Hill-Sachs Lesion`?

Most people recover completely from an injury. Even if you have surgery, you should be able to return to most of your normal activities and sports once your shoulder heals.

However, once you dislocate your shoulder, you are much more likely to get injured again. Some studies have found that more than 90% of athletes under the age of 25 who dislocate their shoulder in a contact sport will re-injure the same shoulder in the future.

Therefore, talk to your doctor or surgeon before resuming any physical activity – especially contact sports. They can explain what to expect and how to prevent future dislocations. Proper physical therapy can also help reduce this risk.

Will I be unable to go to work or school until I recover?

If you are unable to do your job or schoolwork without moving your arm while your shoulder is immobilized, you may not be able to go to work or school. Your doctor will tell you what movements and positions to avoid until you recover. Follow those instructions carefully.

When should I go to the emergency room?

If you have had a major accident (trauma) , go to the emergency room immediately.

If you think your shoulder is dislocated:

• Go to the emergency room or call 1990.
• Don't move your hand. Keep it close to your body.
• Do not try to reposition your shoulder yourself. Do not let anyone other than a doctor do it. If a non-specialist tries to reposition your shoulder, you may damage blood vessels, muscles, ligaments, and nerves.
• Place an ice pack on the injured area. This will reduce swelling and pain.
• Painkillers (e.g. paracetamol, or `NSAIDs` - Nonsteroidal anti-inflammatory drugs, as prescribed by your doctor) can help reduce pain and other symptoms. However, do not take more than the recommended dose.

What questions should I ask my doctor?

When you have a situation like this, it's a good idea to ask your doctor about the following:

• Do I need surgery to repair my Hill-Sachs Lesion? If so, what kind?
• How long do I need to keep my arm immobilized?
• When should I start physical therapy? How long will it take?
• When will I be able to play sports or exercise again? What kinds of things can I do first?
• What can I do to prevent my shoulder from popping again?

What is the difference between a `Hill-Sachs Lesion` and a `Reverse Hill-Sachs Lesion`?

A `Hill-Sachs Lesion` and a `Reverse Hill-Sachs Lesion` are the same type of injury. The only difference is which side of the ball-like part of your upper arm bone (`Humerus`) the injury is on .

• A `Hill-Sachs Lesion` is a bump that occurs on the back side (in medical terms, `posterolateral aspect`) of the ball-like part of the shoulder when it is pushed forward from the `anterior side`.
• A `Reverse Hill-Sachs Lesion` is a bump that occurs on the front side (in medical terms, the `anteromedial aspect`) of the ball-like part of the shoulder when it is thrown from the `posterior side`.

Both are diagnosed and treated in much the same way.

What is the difference between a `Hill-Sachs Lesion` and a `Bankart Lesion`?

`Hill-Sachs Lesion` and `Bankart Lesion` are two types of injuries associated with shoulder dislocation. However, they are different.

• A `Hill-Sachs Lesion` is a bone spur that occurs when your shoulder slips forward from side to side (anterior glenohumeral dislocation), causing the head of the upper arm bone (`humerus`) to become compressed, causing a lump in the shoulder socket. This means that this is damage to the bone.
• A `Bankart Lesion` is an injury to the protective cartilage ring around the shoulder joint (called the `Labrum`). A `Bankart Lesion` is a tear in this `Labrum`. This can happen from a dislocation or a slight movement (`subluxation`). Once a shoulder is dislocated, it is more likely to happen again. If the shoulder continues to dislocate or `subluxate`, the `Labrum` can become further damaged (such as a `SLAP tear`).

A dislocated shoulder can be a very painful and frightening experience. Suddenly unable to move your arm, feeling like your shoulder is no longer where it used to be, is a huge shock. Never try to "tock" your shoulder and put it back together. Go to the emergency room immediately and seek medical attention as soon as possible.

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If you have dislocated your shoulder once, whether you have a Hill-Sachs Lesion or not, you are at a higher risk of re-injuring it in the future. So, talk to your doctor during your recovery. That way, you can get a better idea of ​​what to expect and how to protect your shoulder.

Take-Home Message

Okay, so let's recap the most important things we talked about in this `Hill-Sachs Lesion`:

• This happens when a shoulder is dislocated , and the ball-like part of the upper arm bone (the `humerus`) hits the socket of the shoulder blade, causing a small dent-like bruise to form on the bone.
• It has the same symptoms as a dislocated shoulder, such as severe pain, inability to move the arm, and swelling , but it can be a little more intense.
• In most cases, the shoulder can be repositioned, immobilized, and treated with physical therapy without surgery .
• If the wound is large (more than 20% of the bone), surgery may be necessary.
• The most important thing is to seek medical advice immediately if you dislocate your shoulder. Don't try to fix it yourself.
• If you dislocate your shoulder once, you are more likely to dislocate it again. Therefore, it is very important to follow medical advice and keep your shoulder strong.

If you have any more questions about this, don't be afraid to ask your doctor or midwife. Stay healthy!

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