Hill-Sachs Lesion: Understanding Causes, Symptoms, and Recovery
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 15, 2026
Quick Answer: What is a Hill-Sachs lesion?
A Hill-Sachs lesion is a compression fracture or dent on the head of the humerus, the upper arm bone, that occurs during a shoulder dislocation. It happens when the ball of the arm bone is forced against the edge of the shoulder socket. This injury matters because it increases the likelihood of recurrent shoulder dislocations in the future.
What the research says
Adding remplissage sharply cuts re-dislocation. A meta-analysis of 12 studies found total recurrence after arthroscopic Bankart repair plus remplissage was 3.2% versus 16.8% with Bankart repair alone, with a similar recurrence rate to the Latarjet procedure (9.8% vs 7.0%) but far fewer complications (0.5% vs 8.6%) (Hurley et al., J Shoulder Elbow Surg, 2020) [2].
The benefit holds for engaging lesions. Across 7 studies and 837 patients with an engaging Hill-Sachs defect, adding remplissage lowered the odds of recurrent instability (odds ratio 0.11, 95% CI 0.05 to 0.24), a roughly 9-fold decrease, with Rowe and WOSI outcome scores comparable to Bankart repair alone (Pawłuś et al., Am J Sports Med, 2025) [3].
Bone loss on both sides changes the surgical plan. A review of 13 studies (778 patients) found pooled recurrence of 19.5% after Bankart repair, 4.4% after remplissage, and 8.7% after Latarjet, and concluded that a Hill-Sachs defect combined with glenoid bone loss should prompt more aggressive surgery such as a bone block procedure (Gowd et al., Am J Sports Med, 2019) [4].
Key Takeaways
Category | Details |
Definition | A dent or compression fracture in the humeral head caused by shoulder dislocation [1]. |
Common Causes | Sports injuries, falls, and motor vehicle accidents resulting in dislocation [1]. |
Primary Symptoms | Severe pain, shoulder deformity, weakness, and inability to move the arm [1]. |
Diagnosis | Physical examination followed by imaging tests like X-rays, MRI, or CT scans [1]. |
Treatment | Range from closed reduction and physical therapy to surgical repair for large lesions [1]. |
Recovery Time | Typically a few months, involving immobilization and progressive physical therapy [1]. |
Understanding the Hill-Sachs Lesion
The shoulder is a complex ball-and-socket joint where the head of the humerus fits into the glenoid cavity of the scapula. A Hill-Sachs lesion occurs when a dislocation forces the rounded humeral head against the sharp edge of the glenoid, creating a structural divot [1]. This injury is often accompanied by other shoulder damage, such as Bankart lesions, which affect the labrum and further compromise joint stability [1].
Symptoms and Warning Signs
The symptoms of a Hill-Sachs lesion are virtually identical to those of the shoulder dislocation that caused it. Patients typically experience sudden, intense pain and a visible deformity where the shoulder appears out of place [1]. Other common signs include significant swelling, bruising, and muscle spasms as the body attempts to protect the injured joint [1]. In some cases, nerve involvement may lead to numbness or tingling that extends down the arm into the hand and fingers [1].
Causes and Risk Factors
Shoulder dislocations are the primary cause of Hill-Sachs lesions, with anterior (forward) dislocations being the most common type to produce this specific bone defect [1]. Certain populations are at a higher risk, particularly young males between the ages of 15 and 30 and athletes participating in high-impact contact sports [1]. Once a shoulder has been dislocated, the structural changes caused by a Hill-Sachs lesion significantly increase the risk of future instability and recurrent dislocations [1].
Diagnostic Procedures
Healthcare providers diagnose Hill-Sachs lesions through a combination of physical assessment and advanced imaging. During the initial exam, the provider will check for range of motion, strength, and signs of joint instability [1]. Imaging is essential to determine the size and depth of the lesion, with X-rays often serving as the first step, followed by MRI or CT scans to provide a detailed view of the bone and surrounding soft tissues [1].
Treatment and Management Options
The approach to treating a Hill-Sachs lesion depends largely on the size of the defect and the patient's activity level. For smaller lesions—typically those covering less than 20% of the humeral head—non-surgical management is often successful [1]. This involves a “closed reduction” to reset the shoulder, followed by a period of immobilization in a sling and a structured physical therapy program to restore strength and stability [1].
Treatment Type | Description |
Closed Reduction | A non-surgical procedure where a provider manually realigns the shoulder joint [1]. |
Immobilization | Using a sling or splint for several weeks to allow the bone and tissues to heal [1]. |
Physical Therapy | Exercises focused on strengthening the rotator cuff and shoulder stabilizers [1]. |
Remplissage | A surgical technique where soft tissue is used to fill the humeral head defect [1]. |
Bone Grafting | Surgery to transplant bone tissue into the lesion to restore the bone's shape [1]. |
Surgical Intervention
When a Hill-Sachs lesion is large (exceeding 20% of the humeral head) or if the patient experiences chronic instability, surgery may be required. Common procedures include the remplissage technique, which fills the defect with soft tissue from the adjacent shoulder capsule and tendon, or bone grafting to rebuild the humeral head [1]. In extreme cases involving extensive damage to the joint, a partial or total shoulder replacement may be the only way to restore function [1].
Long-Term Outlook and Prevention
While most individuals achieve a full recovery and return to their normal activities, the long-term outlook involves an increased risk of developing shoulder arthritis later in life [1]. Prevention focuses on reducing the risk of falls and sports-related injuries through the use of proper protective equipment and maintaining shoulder strength [1]. For those who have already experienced a dislocation, adhering to a comprehensive physical therapy program is the most effective way to prevent future occurrences [1].
Conclusion
A Hill-Sachs lesion is a significant injury that requires prompt medical attention and a dedicated recovery plan. By understanding the nature of the injury and following the recommended treatment protocols, patients can maximize their chances of returning to a full, active lifestyle while minimizing the risk of long-term complications.
FAQ
What is a Hill-Sachs lesion?
It is a dent or fracture on the back of the upper arm bone caused by a shoulder dislocation. [1]
How does it happen?
It occurs when the arm bone is forced against the edge of the shoulder socket during a dislocation. [1]
Is it the same as a dislocated shoulder?
No, it is a specific bone injury that results from a dislocation. [1]
What are the symptoms?
Severe pain, swelling, deformity, and an inability to move the arm. [1]
How is it diagnosed?
Through physical exams and imaging like X-rays, MRI, or CT scans. [1]
Can it heal on its own?
Small lesions heal with physical therapy, but the bone dent remains permanent. [1]
Do all Hill-Sachs lesions need surgery?
No, only large or severe lesions typically require surgical repair. [1]
What is a remplissage procedure?
A surgery that fills the bone dent with nearby soft tissue. [1]
What is bone grafting for this injury?
It involves adding bone tissue to the dent to restore the bone's shape. [1]
How long is recovery?
Usually a few months, including weeks of immobilization and months of therapy. [1]
Can I play sports again?
Most people return to sports after a full recovery and clearance from a doctor. [1]
What is the risk of re-injury?
It is high after a first dislocation; 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. [1]
Does it cause arthritis?
Yes, it increases the long-term risk of shoulder arthritis. [1]
What is an anterior dislocation?
A dislocation where the arm bone moves forward out of the socket. [1]
What is a Bankart lesion?
An injury to the shoulder socket's labrum that often occurs with Hill-Sachs. [1]
Is the pain severe?
Yes, shoulder dislocations and Hill-Sachs lesions are typically very painful. [1]
Should I use ice or heat?
Ice is generally recommended initially to reduce swelling. [1]
Can I drive with a Hill-Sachs lesion?
Not while your arm is immobilized in a sling. [1]
What exercises help?
Rotator cuff strengthening and shoulder stabilization exercises. [1]
Is physical therapy mandatory?
It is highly recommended to prevent future dislocations. [1]
Can children get Hill-Sachs lesions?
Yes, though they are most common in people aged 15 to 30. [1]
Are males more at risk?
Yes, males are more than twice as likely to dislocate their shoulders as females. [1]
What is a closed reduction?
The process of a doctor popping the shoulder back into its socket. [1]
Will I need a sling?
Yes, usually for several weeks following the injury. [1]
What happens if I don't treat it?
You may face chronic pain and frequent shoulder dislocations. [1]
Can a fall cause this?
Yes, falls are a leading cause of shoulder dislocations. [1]
Are car accidents a cause?
Yes, the impact can force the shoulder out of its socket. [1]
What is a humeral head?
The ball-shaped top of the upper arm bone. [1]
What is the glenoid?
The shallow socket in the shoulder blade where the arm bone sits. [1]
Is a CT scan better than an X-ray?
A CT scan provides more detail about the size of the bone defect. [1]
What is an MRI used for?
It helps identify damage to soft tissues like ligaments and tendons. [1]
Can I prevent this injury?
Using safety equipment and strengthening shoulder muscles can reduce risk. [1]
Is the injury permanent?
The dent in the bone is permanent, but function can be restored. [1]
What is shoulder instability?
A condition where the shoulder easily slips out of its socket. [1]
What is a prosthetic shoulder?
An artificial joint used in shoulder replacement surgery. [1]
Does age affect recovery?
Yes, younger patients may have a higher risk of re-injury. [1]
Can I use NSAIDs for pain?
Yes, over-the-counter pain relievers can help manage symptoms. [1]
What is muscle atrophy?
Weakening of the muscles due to lack of use during recovery. [1]
Is the surgery outpatient?
Many shoulder surgeries are now performed as outpatient procedures. [1]
When should I see a doctor?
Immediately after any shoulder trauma or suspected dislocation. [1]
Can I move my fingers?
You should be able to, unless there is significant nerve damage. [1]
What is a shoulder specialist called?
An orthopedic surgeon. [1]
Is the injury visible from the outside?
The dislocation is visible, but the bone dent is not. [1]
Does smoking affect healing?
Yes, smoking can slow down bone and tissue recovery. [1]
What is a labrum?
A ring of cartilage that deepens the shoulder socket. [1]
Can a Hill-Sachs lesion happen without dislocation?
No, it is by definition caused by a dislocation. [1]
Is it a common sports injury?
Yes, especially in football, rugby, and wrestling. [1]
How do I know if I need surgery?
Your doctor will decide based on the size of the lesion and your symptoms. [1]
Can I sleep on my side?
Not usually during the initial weeks of recovery. [1]
What is the success rate of surgery?
Most patients achieve good to excellent results with surgery and therapy. [1]
Further Reading
American Academy of Orthopaedic Surgeons. Professional society for orthopaedic surgeons.
Arthritis Foundation. Patient resources on arthritis and joint health.
Related Reading
Bankart Lesion: The Shoulder Cartilage Tear That Almost Always Follows a Frontward Dislocation — and Why Recovery Takes Months, Not Weeks covers the socket-side injury that often occurs with a Hill-Sachs lesion.
Dislocated Shoulder: Symptoms, First Aid, Treatment & Recovery — Complete Guide explains shoulder dislocation first aid, treatment and recovery.
Understanding Shoulder Arthroscopy: A Minimally Invasive Approach to Joint Repair describes the keyhole surgery used to repair shoulder damage.
SLAP Tear: Understanding Shoulder Labrum Injuries covers tears of the shoulder labrum and how they are treated.
Sources
Cleveland Clinic. Hill-Sachs Lesion: What It Is, Symptoms & Treatment. Cleveland Clinic. Last updated October 15, 2022. https://my.clevelandclinic.org/health/diseases/24304-hill-sachs-lesion
Hurley ET, Toale JP, Davey MS, et al. Remplissage for anterior shoulder instability with Hill-Sachs lesions: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2020;29(12):2487-2494. PMID 32650087. https://doi.org/10.1016/j.jse.2020.06.021
Pawłuś N, Kanak M, Frankiewicz A, et al. Remplissage May Decrease the Redislocation Rate After Arthroscopic Bankart Repair in Patients With an Engaging Hill-Sachs Defect: A Systematic Review and Meta-analysis of Studies With Minimal 2-Year Follow-up. Am J Sports Med. 2025;53(3):717-726. PMID 38742747. https://doi.org/10.1177/03635465241249492
Gowd AK, Liu JN, Cabarcas BC, et al. Management of Recurrent Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review to Assess Critical Bone Loss Amounts. Am J Sports Med. 2019;47(10):2484-2493. PMID 30148653. https://doi.org/10.1177/0363546518791555
Disclaimer
The information provided in this article is for educational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of any medical condition.
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