Hill Sachs lesion
The osseous deficiency of the humeral head known as the Hill-Sachs lesion is commonly linked to anterior shoulder instability. When glenohumeral instability is present, the prevalence of these lesions is quite high, approaching 100% in individuals with recurrent anterior shoulder instability. It has been reported that individuals with posterior shoulder instability have reverse Hill-Sachs lesions. The most prevalent cause of Hill-Sachs lesions is anterior glenohumeral instability, which usually happens when the shoulder is in external rotation and abduction. The capsulolabral structures of the shoulder are strained and frequently damaged as the humeral head is moved anteriorly. A compression fracture develops along the posterosuperolateral side of the humeral head when it meets the anterior glenoid process as the humeral head translates more anteriorly. Since the static gleno humeral restrictions (labrum, capsule) weaken with each incident of instability, the anterior soft-tissue structures injury is especially significant in recurring instances of instability. As it repeatedly comes into touch with the tougher cortical bone of the anterior glenoid, this attenuation makes it simpler for the comparatively softer cancellous bone of the humeral head to sustain ongoing injury. Usually connected to anteroinferior glenohumeral dislocation, the classic Hill-Sachs lesion is a bone deformity of the posterosuperolateral humeral head1.
If you are suffering from hill sachs lesion than you may experience
- Difficulty to perform shoulder joint movements; specifically abduction and external rotation.
- Crepitus or click sounds during shoulder movements.
- Sense of instability in shoulder joint
- Rotator cuff pathology, biceps tendon pathology1.
A physical therapist will start with a comprehensive clinical examination, concentrating on the patient’s medical history and current symptoms. The shoulder’s strength, stability, and range of motion will all be evaluated by the therapist. To evaluate any restrictions or discomfort during shoulder movement, especially external rotation, both passive and active range of motion tests will be carried out. Special tests like the Bony apprehension Test or Jobe relocation Test may be used to assess the shoulder instability, which could indicate the presence of a Hill-Sachs lesion.
According to brandon d et al; Significant osseous lesions can be reliably screened with the bony apprehension test. It has higher sensitivity (100%) compared to preoperative plain radiographs’ which has only 50% sensitivity 2. These initial steps help the therapist determine the likelihood of a Hill-Sachs lesion and guide the appropriate physical therapy interventions. For a patient with a Hill-Sachs lesion, the first phase of physical therapy treatment is to minimize discomfort, encourage healing, and restore a minimum level of shoulder mobility while preventing additional instability. The therapist may suggest wearing a brace or sling to restrict mobility and enable the shoulder joint to heal, depending on the extent of the lesion and any accompanying shoulder instability. For patients with a Hill-Sachs lesion, scapular stabilization exercises are an essential part of physical therapy because they enhance shoulder stability and mechanics. Strengthening the muscles surrounding the scapula promotes greater control and lowers the chance of re-dislocation or additional injury. The scapula, also known as the shoulder blade, is essential in providing a firm foundation for the shoulder joint. Also pendulum exercises will be added according to need of the patient. As Pendulum exercises assist in preserving shoulder joint range of motion without overstretching the damaged tissues. To avoid stiffness, this is especially crucial in the early phases of recovery. Strengthening of rotator cuff, deltoid & periscapular muscles will play an important role in the treatment. Together, these muscles give the shoulder joint dynamic stability, particularly during the healing process following an injury such as a Hill-Sachs lesion. Regular exercise that targets these muscle groups improves shoulder mechanics overall, facilitates a safe return to activity, and helps ward against further shoulder issues3. In summary, whether a Hill-Sachs lesion is managed non-operatively or surgically, physical therapy is an essential first step in regaining shoulder stability, function, and strength. A good recovery depends on early intervention, appropriate technique, and a well-structured rehabilitation program. These factors will enable you to resume your regular activities or sports with more confidence and less shoulder instability.
References:
1. Provencher, Matthew T. MD; Frank, Rachel M. MD; LeClere, Lance E. MD; Metzger, Paul D. MD; Ryu, J. J.; Bernhardson, Andrew MD; Romeo, Anthony A. MD. The Hill-Sachs Lesion: Diagnosis, Classification, and Management. Journal of the American Academy of Orthopaedic Surgeons 20(4):p 242-252, April 2012. | DOI: 10.5435/JAAOS-20-04-242
2. Brandon D. Bushnell, R. Alex Creighton, Marion M. Herring, The Bony Apprehension Test for Instability of the Shoulder: A Prospective Pilot Analysis, Arthroscopy: The Journal of Arthroscopic & Related Surgery, Volume 24, Issue 9, 2008, Pages 974-982,
3. Chen, A. L., & Bosco, J. A. (2006). Glenohumeral Bone Loss and Anterior Instability. Bulletin of the NYU Hospital for Joint Diseases, 64.
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