Hill – Sachs lesion

HILL - SACHS LESION

A Hill-Sachs lesion is an injury to the top of the humerus, usually like a small dent or bony defect, that most often happens when the shoulder dislocates forward. In simple terms, when the shoulder comes out of place, the head of the humerus can hit the edge of the socket and get damaged. It often appears together with other shoulder instability injuries and may be linked with pain, a feeling that the shoulder is not secure, fear in certain positions and reduced confidence during overhead activity.

What a Hill-Sachs lesion is

A Hill-Sachs lesion usually appears after a shoulder dislocation and may cause deep joint pain, a sense of instability or fear when the arm moves back and out to the side, when you lift weight overhead or when you use the arm more dynamically, and many people feel that the shoulder no longer has the same security as before or may slip again in certain positions; because the body tries to protect the area, it is common to unconsciously avoid some angles, lose comfort with overhead movement, overwork the shoulder blade and neck muscles and feel less confident with work, weights or sport, yet rehabilitation usually focuses on first calming the joint, then gradually restoring movement, strengthening the muscles that stabilise the shoulder and rebuilding control and tolerance so the shoulder works more steadily and with less fear in daily life.

Shoulder blade control and better support

Rehabilitation first focuses on reducing pain and the sense of instability and on rebuilding a safe base for shoulder movement without pushing too early into positions that create fear or the feeling that the shoulder may slip. Then we progressively train shoulder blade control, the rotator cuff and trunk muscles so the joint is better supported in real life, and as the shoulder settles we add more functional drills for support, pushing, pulling and later more demanding overhead movement or return to sport, always aiming to improve confidence without strong flare-ups or new instability episodes.

What exactly is a Hill-Sachs lesion?

It is a bony injury on the head of the humerus that usually happens when the shoulder dislocates forward and the humeral head impacts the edge of the socket. It is essentially a dent in the bone linked to shoulder instability.

How is it usually caused?

It usually happens at the moment of a shoulder dislocation after a fall, collision or sports injury. The more significant the instability event, the greater the bony injury may be.

What symptoms are most common?

The most common symptoms are deep shoulder pain, a sense of instability, apprehension in certain positions, reduced confidence when opening the arm and difficulty with overhead movement or weights. For many people the main issue is not only pain but also the feeling that the shoulder could slip again.

How does physiotherapy help in practical terms?

Physiotherapy helps improve shoulder blade control, strengthen the rotator cuff and trunk muscles, maintain or restore shoulder movement and structure a safer return to work, weights or sport with less fear and better stability.

When can I return to weights or sport?

Return is gradual when the shoulder feels more stable, when basic exercises are tolerated without strong pain or slipping sensations and when more demanding positions can be tested safely. Timing varies with injury severity and whether other shoulder injuries are also present.

How can I reduce the chance of it happening again?

Consistent strengthening of the shoulder blade, rotator cuff and trunk, gradual progression in training and avoiding sudden return to heavy or unstable positions after time off all help reduce recurrence risk. When the shoulder works in a more coordinated and stronger way the risk of future instability episodes also tends to drop.

Is surgery always necessary?

Not always. Treatment depends on lesion size, associated injuries and whether the shoulder continues to dislocate or feel unstable. In many cases conservative rehabilitation is the first step while function and stability are monitored.

Hill – Sachs lesion