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The Hill-Sachs lesion was first reported in 1940 by American radiologists Harold Arthur Hill and Maurice David Sachs. In their publication, they presented a study involving 119 cases of shoulder dislocation, demonstrating that the lesion resulted from the direct compression of the humeral head against the anterior glenoid rim during dislocation. This work clarified the mechanism behind the lesion, which had been recognized as a sign of shoulder dislocation prior to their research, but lacked an understanding of its precise cause. What is a Hill-Sachs lesion? A Hill-Sachs lesion is a type of injury
that affects your humerus (your upper arm bone). You might see it referred to
as a Hill-Sachs defect. It’s caused when you experience adislocated shoulder.
⬆️ 上图是肩关节后方的解剖，关节囊已经被掀开。可以看到，肩关节脱位时，肱骨头后外侧部位形成的骨性压缩性损伤。它通常发生在肩关节前脱位时，由于肱骨头撞击肩胛骨的前缘（通常是盂缘）而造成凹陷或压痕。这种损伤会削弱肩关节的稳定性，增加肩关节再次脱位的风险。如果Hill-Sachs损伤较大，可能需要手术修复，以避免复发性脱位。 A Hill-Sachs lesion is like a dent in your
bone. If you dislocate your shoulder and your humerus is pressed against the
lip of its socket in your scapula (shoulder blade) the ball at the top of it
can be damaged.
上图：Large Hill-Sachs deformity 大Hill-Sachs损伤 Most people recover from a dislocated shoulder that causes a Hill-Sachs lesion in a month or two with a few months of physical therapy. 大多数人在经过几个月的物理治疗后，通常在一到两个月内就能从导致 Hill-Sachs 损伤的肩关节脱位中恢复。 Usually only severe Hill-Sachs lesions
require surgery to repair. Who is affected by Hill-Sachs lesions? Because accidents like traumas or falls
usually cause shoulder dislocations, anyone can dislocate their shoulder and
develop a Hill-Sachs lesion. Some groups of people are more likely to
dislocate their shoulders, including: ·Athletes who play contact sports. ·Male. ·People between 15 and 30 years old. ·Anyone who has previously dislocated their shoulder. Male at are more than two times more likely
to dislocate a shoulder than female. 男性比女性个体更容易发生肩关节脱位，概率高出两倍以上。 How common are Hill-Sachs lesions? Only around 10 per 100,000 people in the
U.S. dislocate a shoulder each year. How does a Hill-Sachs lesion affect my
body? Usually, a Hill-Sachs legion itself won’t
affect you any more than the dislocation that caused it. It might make your
symptoms like pain feel more severe. It will be hard (or impossible) to move
your arm right away after the injury. If you can move your arm or shoulder, it
will probably be extremely painful and uncomfortable. A Hill-Sachs lesion might make your injury
take longer to recover. If you have a large Hill-Sachs lesion after your
shoulder is dislocated, you may be more likely to experience another
dislocation in the future. People who have dislocated a shoulder are
more likely to developshoulder arthritis in that joint over time. Symptoms and Causes症状与病因 What are the symptoms of a Hill-Sachs
lesion? Hill-Sachs lesions usually have the same
symptoms as the dislocated shoulder that causes them, including: ·Extreme pain. 极度疼痛。 ·Weakness. 无力。 ·Inability to move your arm. ·Your shoulder being visibly out of place. ·Swelling. 肿胀。 ·Bruising or discoloration. ·Muscle spasms. 肌肉痉挛。 ·Numbness, tingling or weakness in your arm, hand or fingers. If you have a Hill-Sachs lesion, you might
experience more severe versions of these symptoms. Go to the emergency room right away if you
have a dislocated shoulder or experience trauma. What causes Hill-Sachs lesions? Dislocated shoulders cause Hill-Sachs
lesions. Your shoulder is what’s known as a
ball-and-socket joint. The head of your humerus (its top, near your shoulder)
is shaped like a ball that fits into the socket in your scapula (you shoulder
blade). If your shoulder is dislocated forward
(away from the front of your body), the rounded head at the top of your humerus
can get pressed into the edge of the socket it’s usually in. This pressure can
damage the head of your humerus enough to dent the ball. The most common causes of dislocated
shoulders include: ·Sports injuries. 运动损伤。 ·Falls. 跌倒。 ·Car accidents. 车祸。 Diagnosis and Tests诊断与检查 How is a Hill-Sachs lesion diagnosed? Your healthcare provider will diagnose a
Hill-Sachs lesion while they’re examining your dislocated shoulder. They’ll
physically examine your arm and shoulder, and will use imaging tests to take
pictures of the damage inside your body, including: ·X-rays. X 光片。 ·MRI (magnetic resonance imaging). ·A CT (computed tomography) scan.
上图：肩关节正位、上臂内旋显示压缩骨折（灯泡位）
上图是MRI检查 Management and Treatment管理和治疗 How are Hill-Sachs lesions treated? Which treatment you’ll need for a
Hill-Sachs lesion depends on how big it is. If the lesion is 20% or less of
your humeral head, you’ll probably only need the usual treatment for a
dislocated shoulder. Closed reduction闭合复位 The most important treatment for a
dislocated shoulder is getting your arm back into its socket. This is called a
closed reduction. During this non-surgical procedure, your provider will
physically push and pull your body on the outside to set (align) your shoulder.
They might give you a local anesthetic to numb the area around you shoulder or
sedatives to relax your whole body. Immobilization制动 After your closed reduction, you’ll need to
wear a splint or sling to hold your injured shoulder in place. This is called
immobilization. This will take stress off it and help it heal. Your provider might recommend icing your
injured shoulder a few times a day. You may need to do light exercises so your
shoulder doesn’t tighten orfreeze. Ask your provider how long you’ll need to wear the
splint or sling, and how often you should exercise your shoulder. Most people
need to immobilize their shoulder for a few weeks. Physical therapy物理治疗 As your shoulder heals, you’ll need to
start physical therapy to help it regain its strength and ability to move. At
first, you’ll probably only have stretches to loosen your shoulder and make
sure it’s not too tight. Eventually, your provider or physical therapist will
have you add in strength exercises to strengthen yourmuscles and ligaments.
This will help reduce your risk of future dislocations. Most people need
several months of physical therapy after a shoulder dislocation. Hill-Sachs lesion surgery If the Hill-Sachs lesion covers more than
20% of your humerus head, you might need surgery to repair it. The most common
techniques include: ·Remplissage procedure: Your surgeon will
fill the indent caused by the Hill-Sachs lesion with soft tissue that’s
repaired (usually the capsule and tendon in your shoulder next to the injury). ·Bone grafting: Your surgeon will insert additional
bone tissue to repair the damage to your humerus. This is sometimes called bone
augmentation. ·Shoulder replacement: If there’s significant damage
to your humerus, scapula and other tissue in your shoulder, you might need a
shoulder replacement. Your surgeon will replace the damaged parts of your
shoulder with prosthetic (artificial) pieces. How long does it take to recover from a
Hill-Sachs lesion? It usually takes a few months to recover
from a Hill-Sachs lesion. Your shoulder will be immobilized for a few weeks,
and you’ll need months of physical therapy after that. How long it takes your specific injury to
heal depends on a few factors: ·What caused it. 是什么引起的。 ·Any other injuries or damage inside your shoulder. ·Which treatments you needed, or if you needed surgery. Your provider or surgeon will give you a
specific recovery timeline for your injury. Prevention预防 How can I prevent a Hill-Sachs lesion? Because accidents like falls or sports
injuries typically cause dislocated shoulders, there’s not usually anything you
can do to prevent a Hill-Sachs lesion. Follow these general safety tips to reduce
your risk of an injury: ·Always wear your seatbelt. ·Wear the right protective equipment for all activities and sports. ·Make sure your home and workspace are free from clutter that could
trip you or others. ·Always use the proper tools or equipment at home to reach things.
Never stand on chairs, tables or countertops. ·Use a cane or walker if you have difficulty walking or have an
increased risk for falls. Outlook / Prognosis展望 / 预后 What can I expect with a Hill-Sachs
lesion? Most people make a full recovery after
their injury. Even if you need surgery, you should be able to return to most or
all your activities and sports after your shoulder has healed. You’re much more likely to re-injure a
shoulder you’ve dislocated before. Some studies have found that more than 90%
of athletes younger than 25 who dislocate a shoulder during a contact sport
re-injure the same shoulder in the future. Talk to your provider or surgeon before
resuming any physical activities — especially contact sports. They’ll help you
understand what to expect and how you can prevent future dislocations. Will I need to miss work or school while
I’m recovering from a Hill-Sachs lesion? You might need to miss work or school while
your shoulder is immobilized if you can’t do your job or schoolwork without
moving your injured shoulder. Your provider will tell you which motions or
positions to avoid while you’re recovering. Living With生活指导 When should I go to the emergency room? Go to the emergency room if you’ve
experienced trauma. If you think your shoulder is dislocated: ·Go to an emergency room or call 911 or your local emergency number. ·Don’t move your arm. Keep it close to your body. ·Don’t try to jam your shoulder back into place, and don’t let anyone
other than a healthcare provider try to. If anyone other than an expert tries
to put your shoulder back into place they can damage blood vessels, muscles,
ligaments and nerves. ·Apply an ice pack to the injured area to reduce swelling and pain. ·Over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) can help
reduce your pain and other symptoms. Don’t take more than the recommended dose. What questions should I ask my doctor? ·Will I need surgery to repair the Hill-Sachs lesion? ·How long will my arm need to be immobilized? ·When will I start physical therapy? ·When can I resume playing sports or working out? Additional Common Questions What is the difference between a
Hill-Sachs lesion and a reverse Hill-Sachs lesion? Hill-Sachs lesions and reverse Hill-Sachs
lesions are the same injury. The only difference is on which side of the ball
of your humerus is damaged. Hill-Sachs lesions are a dent in the back
of the ball from your shoulder dislocating out of the front of its socket (the
anterior side). Reverse Hill-Sachs lesions are a dent in the front of the ball
of your humerus from your shoulder dislocating out of the back of its socket
(the posterior side). They’re diagnosed and treated the same way.
What is the difference between a
Hill-Sachs lesion and a Bankart lesion? Hill-Sachs lesions andBankart lesions are both injuries related to
dislocating your shoulder. Hill-Sachs lesions are a dent in the bone
on the head of your humerus when it’s pressed against the lip of its socket as
you experience an anterior glenohumeral dislocation — the medical term for
dislocating your shoulder forward and away from the front of your body. Bankart lesions are injuries to your
shoulder’s labrum (the protective bumper lining of the joint socket). They’re
caused by shoulder dislocations or subluxations (partial dislocations). If
you’ve dislocated your shoulder once, you have a much higher chance of
dislocating it again in the future. The more you dislocate or subluxate your
shoulder, the more you can damage your labrum (including aSLAP tear). A note from Cleveland Clinic Dislocating your shoulder can be a painful,
scary injury. Suddenly not being able to move your arm (and knowing it’s out of
its socket) is a shock. Don’t try to “pop” your shoulder back in. Go to the
emergency room and get your injury treated by a healthcare provider as soon as
possible. If you’ve dislocated your shoulder once,
you’ll have a higher risk of re-injuring it in the future — whether or not you
had a Hill-Sachs lesion. Talk to your provider while you’re recovering. They’ll
help you understand what to expect and how you can protect your shoulder. 双十一钜惠开启！骨科医生的专属社群，学生专属优惠+11月新动态一览无遗！
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