I think I've talked myself into having surgery for a shoulder problem that has been diagnosed as a Hill-Sachs defect. What are my chances for a successful recovery?
A Hill-Sachs lesion or defect is a fracture of the round head of bone at the top of the humerus (upper arm bone). Usually, this injury occurs when a person has his or her arm cocked back in a ball throwing motion. The shoulder is abducted (moved away from the body) and externally rotated.
In this position, the head of the humerus moves forward. With enough force and/or load, the forward movement can overcome the strength and restraint of the soft tissues holding the shoulder back. The joint capsule is stretched to the breaking point.
Once the soft tissues surrounding the shoulder have stretched enough to tear, then the shoulder can dislocate repeatedly. And with every dislocation, the damaged soft tissues give a little more until the shoulder is unstable and no longer stays in the shoulder socket (glenoid fossa). At the same time, the compression against the bone is enough to cause the fracture described as a Hills-Sachs lesion.
A small lesion or one that is oriented perpendicular (sideways) to the rim of the socket (glenoid rim) can be treated conservatively (without surgery). But larger lesions, parallel defects, and more serious damage often require surgery.
Once the decision has been made to do surgery, then the surgeon must figure out the best approach to take. The first decision will be whether to do the surgery arthroscopically or with an open incision. It may be necessary to combine several different procedures in order to treat all the bony and soft tissue problems that are contributing to the shoulder instability.
Surgical options include bone graft to fill in the bony defect, tissue filling called remplissage, and capsular shift to tighten up the soft tissues. In some cases, a shoulder replacement or resurfacing procedure may be the only way to treat the problem. A newer procedure called disimpaction is being investigated. In this surgery, the fractured bone is lifted up and a layer of bone graft is placed underneath to support it.
Long-term results with each of these approaches are unknown. There is a great need to identify patients who can benefit from conservative care versus those who need surgery. The role of age and activity level (active versus inactive) in treatment outcomes should be investigated as well.
CDR Matthew T. Provencher, MD, et al. The Hill-Sachs Lesion: Diagnosis, Classification, and Management. In Journal of the American Academy of Orthopaedic Surgeons. April 2012. Vol. 20. No. 4. Pp. 242-252.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.