Hill-Sachs Deformity: A Pathognomonic Sign of

Hill-Sachs Deformity: A Pathognomonic Sign of Anterior Should
Published on Cancer Network (http://www.cancernetwork.com)
Hill-Sachs Deformity: A Pathognomonic Sign of Anterior
Shoulder Dislocation
August 03, 2012
By Aleksandra Trifunovic, DO [1] and Curt Stankovic, MD [2]
A Hill-Sachs deformity is a compression injury to the posterolateral aspect of the humeral head
created by the glenoid rim during dislocation.
A 17 year-old female presented to the ED
with the complaint of right shoulder pain. She was walking in a crowded video arcade when she
accidentally bumped her right shoulder against the edge of a door and then fell with her arm
outstretched. She described a “popping-like” sensation in her shoulder. She had no other associated
injuries and complained only of isolated shoulder pain. Her past medical history was insignificant.
She denied any prior surgeries and was not taking any medications.
At the time of her presentation, she rated her shoulder pain as a “13” on a scale of 0 to 10. Her right
shoulder appeared to be very tender to the touch. There was no bruising or swelling, and no
apparent asymmetry was noted between her shoulders. No evident sulcus sign was appreciated. She
denied any loss of sensation, numbness or tingling of her arm and shoulder, and she was
neurovascularly intact. She did have limited range of motion of the shoulder secondary to extreme
pain, and was only able to abduct her shoulder to 35 to 45 degrees. Suspecting a shoulder
dislocation, an AP, AP internal rotation, and scapular Y views of the right shoulder were obtained. The
Figure shows the AP view.
Both the glenohumeral and acromioclavicular joints were intact and showed no displacement on the
radiographs. However, an irregular contour of the posteriolateral humeral head was evident with a
mild cortical depression. These findings were consistent with a Hill-Sachs lesion.
Discussion
A Hill-Sachs deformity is a compression injury to the posterolateral aspect of the humeral head
created by the glenoid rim during dislocation.1 When driven from the glenohumeral cavity during
dislocation, the relatively soft head of the humerus hits against the anterior edge of the glenoid. The
result is a flattening of the posterolateral aspect of the humeral head.
The Hill-Sachs lesion occurs in 35% to 40% of anterior dislocations and in up to 80 % of recurrent
dislocations.2 It is usually best seen on an AP view of the shoulder in internal rotation.1 Most anterior
shoulder dislocations present with swelling and deformity, with loss of the usual rounded contour of
the shoulder.3
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Hill-Sachs Deformity: A Pathognomonic Sign of Anterior Should
Published on Cancer Network (http://www.cancernetwork.com)
The presence of a Hill-Sachs lesion is an extremely specific sign of an anterior shoulder dislocation
and can be used as an indicator that a dislocation has occurred even if the joint has regained its
normal arrangement.
Because our patient was noted to have a Hill-Sachs deformity and her physical exam was clinically
consistent with a shoulder dislocation, we proceeded to reduce her shoulder using the external
rotation technique. On reduction, she had a vast improvement in her range of motion of her right
arm and shoulder, as well as decreased pain. Her neurovascular examination after reduction was
normal. She was discharged home in a shoulder sling and acetaminophen with codeine for pain. She
was also instructed to limit her activity and to follow up with orthopedics in 1 week.
References:
1. Tseng GY. Shoulder Dislocation Imaging [online chapter]. Available at:
http://emedicine.medscape.com/article/395520-overview. Accessed July 18, 2012.
2. Wheeless CR , Clifford R. Hills Sachs Lesion. Wheeless Textbook of Orthopaedics. 2012. Available
at: www.wheelessonline.com/ortho/hill_sachs_lesion.com. Accessed July 20, 2012.
3. Fleisher GR. Textbook of Pediatric Emergency Medicine. 5th edition. Philadelphia; Lippincott
Williams & Wilkins; 2005:1536.
Source URL:
http://www.cancernetwork.com/articles/hill-sachs-deformity-pathognomonic-sign-anterior-shoulder-di
slocation
Links:
[1] http://www.cancernetwork.com/authors/aleksandra-trifunovic-do
[2] http://www.cancernetwork.com/authors/curt-stankovic-md
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