Hill-Sachs lesion

Description

Hill-Sachs lesion: Cortical depression of posterolateral head of the humerus related to impaction of the humeral head with inferior glenoid in anterior shoulder dislocation

The resultant lesion predisposes the shoulder joint to recurrent dislocations, the lesion is larger in relation to the number of dislocations

History

1832Malgaigne noted that following anterior shoulder dislocation a bony defect in the humeral head could be present [Gazette médicale de Paris. 1832. 3:73;506-508]

1906Perthes recognised that the inferior glenoid fracture with detachment of the labrum caused instability of the shoulder and emphasized reattachment of the labrum to stabilize the joint [1906;85: 199-227]

1914 Schultze

1925 – Pilz first demonstrated the fact that the success or failure of the x-ray examination is dependent upon the technique used

1940 – Hill and Sachs popularized the finding; provided radiographic evidence and determined a link between the presence of the lesion and persistent instability. [Radiology. 1940 35:6;690–700.]

Incentive for this study was the discovery within a short period of time of two shoulders, each of which presented a large defect or groove in the posterolateral aspect of the head of the humerus. The defect was variously interpreted by different consultants as due to infection, metastasis, and post-traumatic osteoporosis.”A survey of the standard textbooks on roentgen diagnosis and on orthopedics was of no assistance in differential diagnosis. Accordingly, a detailed study of the literature was made and 119 cases of dislocated shoulder, examined roentgenographically at the San Francisco Hospital between the years 1930 and 1940, were reviewed. This led to a clarification of our original conceptions regarding the nature of this lesion, and identified it not as a late result of dislocation of the shoulder, but as a true fracture.

Associated Persons

Alternative names

  • Hill–Sachs lesion
  • Hill–Sachs fracture
  • Hill–Sachs deformity

Controversies

Prior to the 1940 publication, this type of fracture was already known as a sign of dislocation, but its mechanism and evolution were unknown.

References

  • Malgaigne JF. Chirgurue Pratique: Des Luxations scapulo-humérales. Nouveau moyens de les distinguer des fractures du col de l’humérus. Nouvelle méthode de réduction. Expériences faites à l’Hôtel-Dieu. Gazette médicale de Paris. 1832. 3:73;506-508
  • Berquet JE. Essai sur les luxations scapulo-humérales, accidentelles ou traumatiques: thèse présentée et publiquement soutenue à la Faculté de médecine de Montpellier. 1850 [Ref Malgaigne pp34-35]
  • Perthes G. Über Operationen bei habitueller Schulterluxation. Deutsche Zeitschrift für Chirurgie. 1906;85:199-228
  • Schultze E. Die habituellen Schulterluxationen. Archiv für klinische Chirurgie. 1914;104:138-179
  • Pilz W. Zur Roentgenuntersuchung der Habituellen Schulterverrenkung. Arch. f. klin. Chir 1925;135:1-22
  • Hill HA, Sachs MD. The grooved defect of the humeral head: a frequently unrecognized complication of dislocations of the shoulder joint. Radiology. 35: vol 6 690–700.(December 1940)
  • Gyftopoulos S, Albert M, Recht MP. Osseous injuries associated with anterior shoulder instability: what the radiologist should know. AJR Am J Roentgenol. 2014 Jun;202(6):W541-50. [PMID 24848847]
  • Somford MP, Van der Linde JA, Wiegerinck JI, Hoornenborg D, Van den Bekerom MPJ, Van Deurzen DFP. Eponymous terms in anterior shoulder stabilization surgery. Orthop Traumatol Surg Res. 2017 Dec;103(8):1257-1263. [PMID 28942024]
  • Calandra JJ, Baker CL, Uribe J.The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations. Arthroscopy. 1989;5(4):254-7. [PMID 2590322]
  • Cetik O, Uslu M, Ozsar BK. The relationship between Hill-Sachs lesion and recurrent anterior shoulder dislocation. Acta Orthop Belg. 2007 Apr;73(2):175-8. [PMID 17515227]

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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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