Hill-Sachs lesion: Causes, Symptoms, Treatment and Cost

Hill-Sachs lesion is a type of shoulder injury that occurs when the humeral head (the ball part of the upper arm bone) is forced against the rim of the shoulder blade (glenoid).

The Hill-Sachs lesion can be classified into four different types depending on its severity and size.

• Small Hill-Sachs Lesion: A small Hill-Sachs lesion is considered to be one that is smaller than 10% of the width of the humeral head itself. This type of lesion usually does not require any treatment, as it will usually heal on its own over time and does not impair movement significantly.
• Medium Hill-Sachs Lesion: These lesions are larger than 10% but still smaller than 25% of the width of the humeral head itself. Treatment for this type may include physical therapy and/or surgical intervention, depending on size and severity.
• Large Hill-Sachs Lesion: These lesions are larger than 25% but still smaller than 50% of the width of the humeral head itself and should be treated surgically to improve stability in this area and restore full range motion in this joint segment.
• Severe Hill-Sachs Lesions: These lesions are larger than 50%, often involving more than two thirds (or greater) of the humeral head’s surface area, which require aggressive surgical treatment to ensure thorough removal of all tissue damage as well as restoring integrity to this area in order to restore full range motion within this segment.

Hill-Sachs lesions are caused when the greater tuberosity of the humerus fractures and impacts on the posterior aspect of the head of humerus, resulting in a characteristic indentation or depression.

This type of fracture is typically caused by forceful hyperabduction or external rotation of the shoulder, which frequently occurs in athletes who play contact sports or those involved in motor vehicle collisions.

In addition to direct trauma, Hill-Sachs lesions have been linked to torn rotator cuff injuries and other forms of shoulder joint instability due to various causes including chronic overuse, poor posture, and certain medical conditions such as rheumatoid arthritis.

• The primary symptom of a Hill-Sachs lesion is pain in the shoulder joint, especially when attempting to move it in certain directions.
• Weakness or instability of the shoulder, which can lead to difficulty performing activities such as lifting or reaching overhead.
• A feeling of popping or clicking when the shoulder is moved around, due to the presence of loose fragments within the joint.
• Reduced range of motion due to pain and instability, which can further limit mobility and daily tasks requiring use of the arm.

• The most important preventative measure is to ensure proper technique when performing shoulder activities or exercises. This includes avoiding repetitive overhead motions and excessive shoulder adduction, which can cause the humeral head to crash into the glenoid rim and result in an impact lesion.
• Proper warm-up and stretching prior to any activity can also help reduce the risk of an impact lesion, as this will help reduce tension and tightness in the shoulder joint.
• Strengthening exercises and proper form can also help reduce the forces generated on the humeral head during activities, thus reducing the risk of impact lesions.
• Wearing protective padding or straps while participating in contact sports can also help protect against possible impacts that may cause a Hill-Sachs lesion.
• Lastly, paying close attention to early signs of pain or discomfort in the shoulder should be taken seriously and addressed by a medical professional as soon as possible.

• Physical Exam: During a physical examination, your doctor will check for loss of motion, tenderness around the shoulder joint, deformity, strength, or other signs that may indicate an injury or degenerative disease.
• X-rays: X-rays can be used to provide an image of the bony structure within and around the shoulder joint to look for any fractures, lesions or arthritis in order to determine if there is compression on the humeral head from contact with the acromion process.
• Magnetic Resonance Imaging (MRI): An MRI can provide more detailed images that allow doctors to examine tissues like ligaments and tendons which cannot be seen on an x-ray image. It is especially helpful in determining if there has been damage to any soft tissues that may have been injured in addition to the bone lesion caused by impact with an acromion process.
• Ultrasound: Ultrasound imaging can also be used to evaluate soft tissue structures like tendons and muscles surrounding a Hill-Sachs lesion since these structures are too small to show up on MRI images but still may be injured due to contact with an acromial process during trauma involving falling onto or against one’s shoulder.

• Instability or dislocation of the shoulder joint: Can lead to recurrent episodes of pain and discomfort.
• Muscle imbalance: Can lead to muscular atrophy, which can further aggravate instability in the shoulder joint.
• Nerve entrapment: Can be caused due to impingement around the lesion, leading to tingling, numbness, and even dysfunction in certain areas of the arm or shoulder muscles.
• Arthritis: A wear-and-tear condition caused by recurrent instability of the joint and microtrauma, leading to inflammation and swelling in the shoulder-joint area over time.

• Abhyanga: This Ayurvedic massage technique involves the application of warm oil to the affected area and gentle pressure to reduce stiffness and promote healing.
• Panchakarma: This traditional Ayurvedic detoxification therapy includes five separate treatments that help to cleanse the body of toxins, reduce inflammation, and restore balance.
• Shirodhara: This treatment involves pouring warm oil over the forehead in a steady stream to help reduce stress and tension in the head, neck, and shoulders.
• Nasya: Nasya is an Ayurvedic treatment which involves using herbalized oils or other substances to treat ailments related to the nose, sinuses, throat and head region.
• Raktamokshana: This procedure involves removing toxins from the blood through a combination of massage techniques and ayurvedic medicines such as decoctions or medicated oils.

• To increase calcium and other electrolytes needed for regular bone development and repair, include more dairy products like yoghurt, cheese and milk in the diet.
• Vegetables should form an important part of the diet as they are good sources of vitamins, minerals as well as soluble fibre which helps reduce inflammation associated with Hill-Sachs lesions.
• Furthermore, including high fibre grains like oats or brown rice in meals can aid in digestion and nutrient absorption from food items consumed by people with this condition.
• Additionally, consuming foods high in omega-3 fatty acids can help reduce inflammatory responses triggered by a Hill Sachs lesion. Cold water fish such as tuna and salmon are excellent sources of this beneficial fat while non-fish eaters can opt for walnuts or flax seeds instead to get their omega-3 intake on point!

• Fried Foods: Fried foods are not recommended because they can aggravate any pain caused by the Hill-Sachs lesion due to their high fat and calorie content.
• Sugary Foods & Drinks: Too much added sugars have been known to increase inflammation in the body, potentially worsening any symptoms related to the lesion.
• Alcoholic Beverages: Excessive consumption of alcohol can interfere with proper healing and energise the muscles surrounding the affected area leading to further damage.
• Dairy Products: Dairy products such as ice cream and cheese contain high concentrations of saturated fats which can worsen inflammation in people with Hill-Sachs lesions, making them more painful than usual so they should be kept off your plate when suffering from this condition.
• Caffeinated Beverages & Energy Drinks: Caffeine is a natural stimulant which can aggravate symptoms associated with pain caused by Hill-Sachs lesions therefore consuming large amounts of coffee or energy drinks is not recommended for individuals trying to heal from this condition.

• Arthroscopic Bankart Repair: Involves the suturing of the torn labrum back to its normal anatomic position by arthroscopic means.
• Open Bankart Repair: The labrum is sutured back to its native position through an open procedure, sometimes in combination with a capsulorrhaphy to reinforce and stabilise the repair.
• Remplissage Procedure: This procedure involves smoothing out of any overhang of bone or cartilage that has caused impingement on opposing structures and also repair of any associated bony or ligamentous injuries as needed.
• Latarjet Procedure: This is a relatively invasive procedure that repairs the bony defect, as well as reconstructs the anterior labrum, which can cause impingements due to bone displacement.

The orthopaedic surgeon can diagnose the Hill-Sachs lesion and recommend treatments, such as physical therapy, rest, medications, or surgery.

• Anti-inflammatory drugs: These drugs help reduce inflammation and swelling around the shoulder joint. Examples include corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), and cyclooxygenase (COX)-2 inhibitors.
• Antidepressants: These medications are used to manage depression, which is often associated with shoulder pain due to a Hill-Sachs lesion. Examples include selective serotonin reuptake inhibitors (SSRIs) such as citalopram, escitalopram, and fluoxetine.
• Corticosteroids: These medications are injected directly into the affected area to reduce pain and inflammation caused by the Hill Sachs lesion. Examples include methylprednisolone, betamethasone, and triamcinolone.
• Analgesics: These drugs act as a pain reliever for Hill Sachs lesions by blocking nerve sensation or reducing nerve activity in the affected area of the body that is causing pain for the patient . Examples include ibuprofen, acetaminophen, aspirin, codeine, etc.

Recovery from a Hill-Sachs lesion can take anywhere from several weeks to several months.

This is dependent on the size and location of the lesion, as well as the type of treatment used.

No, the results of treatment for a Hill-Sachs lesion are not permanent.

The goal of these treatments is to improve range of motion, pain relief, and restore function in the shoulder; however, it is difficult to provide a long-term cure due to the instability that is caused by the original defect in the humeral head (the Hill-Sachs lesion).

• Avoid contact sports and activities that involve shoulder movement: Patients with a Hill-Sachs lesion should avoid contact sports and any activity that involves shoulder movement as these activities can cause further damage to the shoulder joint.
• Monitor shoulder movement: After treatment, it is important to monitor the shoulder movement and ensure that it is not overextended or strained as this can cause further damage to the joint.
• Follow up with medical care: It is important for patients to follow up with their medical care provider to ensure that the treatment was successful and there are no signs of recurrence of the lesion.
• Strengthen muscles around the shoulder: Strengthening exercises should be done to help strengthen muscles around the shoulder, which can help protect the joint from further damage.
• Rest: It is important for patients to rest their shoulder in between activities or exercises in order to allow time for healing and prevent further damage from occurring.

Generally, treatment for Hill-Sachs lesions may include surgery to repair the shoulder joint, rehabilitation with physical therapy, and occupational therapy to improve range of motion.

Costs could include hospital stay fees, consultation fees, and fees for any medications or tests needed.

The total cost of treatment could range from around Rs 8,000 - 10,000 INR up to Rs 35,000 INR or much higher depending on severity and type of treatment chosen.

• Surgery: Pain, swelling, discomfort, and possible long-term immobility due to abnormal postures and muscular weakness.
• Physical therapy: Pain at the lesion site, lack of full range of motion (especially abduction), and a decrease in strength and endurance.
• Immobilisation: Muscular atrophy, joint stiffness, decreased range of motion, limited activities during treatment for best results.
• Non-surgical treatments: Pain relief through medications or injections may be necessary to help manage symptoms; rehabilitation is needed for optimal functioning after treatment is complete.

If you have hill-sachs lesions, you should see a nearby doctor because they can cause things like muscle imbalance, nerve entrapment, arthritis, etc. The length of the treatment programme will depend on how bad the problem is.