When the shoulder becomes dislocated (especially anteriorly dislocated), a leak or fracture of the hill occurs at the lateral edge of the humerus.
In this article, we will get acquainted with the dislocation of the front of the shoulder, which leads to Hill-Sachs lesion, and we will continue to explain the ways of treating this complication.
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Shoulder joint anatomy
The shoulder joint is the most mobile joint in the body, which is very prone to dislocation. This joint is Ball-and-socket joint.
The upper end of the humerus, called the head of the arm.
In fact, it is a ball that is placed inside a bowl called the glenoid cavity and inside it moves and rotates in different directions.
Around the edge of this cavity is an important cartilaginous band called the labrum, which is vital for the stability of the shoulder joint.
The head of the arm is larger than the glenoid cavity, and the shoulder muscles, tendons, and ligaments around the joint help keep the shoulder joint stable.
Types of shoulder dislocations
In shoulder dislocations, the upper part of the humerus, called the head of the humerus, protrudes from the cavity inside. This coming out can occur in different directions, which are mentioned below:
- Anterior dislocation of the shoulder joint:
In this type of dislocation of the shoulder, the humerus moves forward, and due to the impact and compression of the humeral head to the edge of the glenoid bowl, a lesion is created in the periphery of the humerus called a Hill-Sachs lesion or fracture.This type of dislocation is the most common type and is usually caused by falling on the ground.
- Posterior dislocation of the shoulder joint:
It is less common and usually occurs when a strong blow is made to the front of the shoulder and the head of the arm protrudes from the back of the glenoid cavity.
Hill-Sachs lesion occurs in the anterior dislocation of the shoulder.
What is a Hill-Sachs lesion and how does it occur?
When the head of the arm suddenly moves forward from inside the glenoid cavity, the part of the back and outer side of the head of the arm that is in contact with the edge of the cavity is damaged and broken, This injury and fracture is called a Hill-Sachs lesion.
Dr. Hill and Dr. Sachs were the first to define this fracture.
Symptoms of shoulder dislocation
When you have a shoulder dislocation, you may not notice a Hill Sachs lesion at the same time; the shoulder dislocation will be accompanied by the following symptoms:
- Severe pain in the area
- Bruising and bleeding at the site
- Swelling and Inflammation
- You are unable to move your shoulders and arms within the normal range of motion.
- The appearance of the dislocated shoulder changes.
- Sometimes the patient keeps his dislocated shoulder with the healthy hand on the other side so that the pain does not aggravate by shaking.
What to do after a dislocation?
In these cases, the best thing to do is to keep the injured hand steady and see an orthopedist. You can use a topical cold compress and ibuprofen to reduce swelling, inflammation, and pain until you see a doctor.
Your doctor will ask you how your shoulder is injured and use imaging techniques to look for possible injuries.
Finally, the dislocated shoulder is replaced by an orthopedist in an appropriate manner.
Shoulder MRI will be most helpful in diagnosing a Hill-Sachs lesion.
Treatment of Hill-Sachs lesion
The type of treatment for a Hill-Sachs lesion or scourge depends on the following factors:
- Size of the lesion
- The location of the lesion
- Existence of accompanying injuries
- Involvement of the glenoid cavity or labrum
If the Hill-Sachs lesion is small and covers only 20% of the head of the arm and is not associated with inflammatory damage, especially to the structure of the glenoid cavity, your doctor may recommend physiotherapy.
If twenty to forty percent of the humerus is fractured or has a Hill Sachs lesion, more serious treatment will be needed if the orthopedist determines that this amount of lesion will cause instability of your shoulder joint in the future.
There are several types of treatment for Hill-Sachs lesion, which are listed below:
- bone augmentation
- Remplissage
- Disimpaction
- resurfacing
- bone augmentation:
This prevents the head of the arm from coming into contact with the glenoid cavity while moving the arm and shoulder.
- Remplissaage :
This surgery is performed for medium-sized Hill-Sash lesions with little involvement of the glenoid cavity.
- disimpaction:
In this technique, a bone graft is made under the site of the Hill-Sash lesion to return the head of the arm to its original position.
This method is suitable for Hill-Sachs lesions and fractures that are less than three weeks old and involve less than 40% of the head of the arm.
- resurfacing :
Depending on the extent of the injury, screws and plates are used or a complete arm replacement is performed.
Joint replacement is used for people with a Hill-Sachs lesion wider than 40% or for people with recurrent shoulder instability. It is best to avoid complete shoulder replacement in young people.
Post-treatment measures
The recovery time after treatment depends on the extent and severity of the lesion, your age and your general health.
After Hill Sachs surgery, your arm is held in place with a sling for three to six weeks. In older people, this period is considered less to prevent joint dryness.
The movements of the shoulder joint should begin gradually. First, the movement of the arm and shoulder is done by a doctor or physiotherapist without your intervention and without muscle contraction.
Gradually limited range of motion of the shoulder begins. During this period (about three months) lifting, pushing and pulling objects is prohibited.
Gradually increase the range of motion of the joint at the discretion of the physician. During the recovery period, swimming, running and throwing movements with the injured hand are prohibited. It usually takes several months for the shoulder to fully recover.
Concluding remarks
In general, the result of shoulder dislocation treatment and Hill Sachs lesion is good if treated correctly and with full treatment, but recurrence of shoulder dislocation is common especially in young people.
About one-third of people with shoulder dislocations develop shoulder arthritis over time.