This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Hill Sachs lesion (HSL)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Hill-Sachs lesion and Bankart lesion (1):

  • common sequelae to recurrent anterior dislocation of the shoulder joint
  • Hill-Sachs lesion
    • is a compression fracture of the posterolateral humeral head due to its compression against the anteroinferior part of the glenoid when the humerus is anteriorly dislocated
    • the anatomical apposition gives a characteristic position of the lesion; the comparable injury caused by posterior dislocation is a reverse Hill-Sachs lesion
  • Bankart lesion
    • commonly seen in patients with an anterior shoulder dislocation
    • defined as a detachment of the anetroinferior labrum associated with a glenoid rim fracture
    • may occur as an isolated injury to the labrum, or it can extend to the bony glenoid margin, where it is called a "bony Bankart"
  • in most cases, both findings are associated together
  • first anatomic description of the traumatic notch on the humeral head was made in 1855 by Malgaigne
    • in 1940 two radiologists, Harold Arthur Hill and Maurice David Sachs, published a paper, in which they made the radiographic description of lesion, naming it Hill–Sachs lesion (HSL)
    • later on the glenoid rim lesions were reported (2)
    • HSL is often linked with recurrent anterior shoulder instability
      • demonstrated in 67–93% of anterior dislocations and can reach an incidence rate of 100% in patients with recurrent anterior shoulder instability (3)
      • typically occurs with an anteroinferior glenohumeral dislocation event
      • young age and hyperlaxity of the ligaments surrounding the glenohumeral joint lead to a predisposition for recurrence of dislocation
      • most common method of determining the HSL is the Calandra classification, which uses arthroscopy to measure the depth of the lesion

Grade

Description

I

Defect in articular surface that does not affect subchondral bone

II

Defect includes subchondral bone

II

  • Large defect in the subchondral bone
  • quantifying bone loss is of utmost importance to decide the best treatment for recurrent anterior glenohumeral instability patients (3)
    • this is the determinant factor influencing the choice of the surgical technique: soft tissue procedure or bone block procedure
    • has been extensively reported in the literature that the limit of glenoid bone loss above which an arthroscopic Bankart repair may fail is >= 25% of the glenoid width
      • this percentage is equivalent to >= 20% of the surface area created by a bestfit circle on the inferior surface of the glenoid
  • 3DCT has become the “gold standard” for Hill-Sachs imaging; however, it has been noted that 3D-MRI produces results that are not significantly different from CT (4)

Reference:

(accessed 10/6/2020)

  • Charousset C, Beauthier V, Bellaïche L, et al. Can we improve radiological analysis of osseous lesions in chronic anterior shoulder instability? Orthop Traumatol Surg Res 2010;96:S88–S93.
  • Maio M et al. How to measure a Hill–Sachs lesion: a systematic review. EFORT Open Rev 2019;4:151-157.
  • Fox JK et al. Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability. Curr Rev Musculoskelet Med (2017) 10:469–479
  • Shibayama K, Iwaso H. Hill-Sachs lesion classification under arthroscopic findings. J Shoulder Elb Surg. 2017;26(5):888–94

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.