Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Practising at Mount Elizabeth Novena Hospital, Singapore
Appointments by prior arrangement
Dr Puah Ken Lee 潘健理
Orthopaedic Surgeon
Shoulder, Elbow & Sports Injuries
Mount Elizabeth Novena Hospital, Singapore
✔ Subspecialty Focus in Shoulder & Elbow, Sports Injuries
✔ Practising at Mount Elizabeth Novena Hospital
✔ Evidence-based treatment, Individualised Care
Hill-Sachs Lesion
A Hill-Sachs lesion is a small dent or compression fracture in the ball of the shoulder joint (the humeral head). It commonly occurs when the shoulder dislocates forwards (anterior shoulder dislocation).
Many Hill-Sachs lesions are small and do not cause long-term problems. However, larger defects may increase the risk of recurrent shoulder instability and influence the choice of treatment.
Finding a Hill-Sachs lesion on an MRI or CT scan does not automatically mean that surgery is required. Treatment depends on the size of the defect, your symptoms, associated injuries and the stability of your shoulder.
What is a Hill-Sachs Lesion?
The shoulder is a ball-and-socket joint.
During an anterior shoulder dislocation, the ball of the shoulder can strike the edge of the socket with enough force to leave a small indentation in the bone.
This indentation is called a Hill-Sachs lesion.
It is one of the most common associated injuries seen after an anterior shoulder dislocation.
Why Does It Matter?
Many small Hill-Sachs lesions heal without causing significant problems.
Larger lesions, however, may:
- Increase the risk of the shoulder dislocating again
- Contribute to recurrent shoulder instability
- Engage with the front of the socket during certain arm positions
- Influence the type of surgery that is recommended
Your orthopaedic surgeon considers the Hill-Sachs lesion together with other factors, such as labral injuries and glenoid bone loss, when planning treatment.
What Causes a Hill-Sachs Lesion?
Hill-Sachs lesions usually occur after:
- Traumatic shoulder dislocation
- Contact sports
- Rugby
- Cycling accidents
- Falls onto an outstretched arm
- Skiing or snowboarding
- Motor vehicle accidents
Repeated shoulder dislocations may enlarge the defect over time.
Symptoms
A Hill-Sachs lesion itself does not usually cause symptoms.
Instead, patients commonly experience symptoms related to the associated shoulder instability, including:
- Shoulder dislocation
- Shoulder slipping out of place
- Apprehension with overhead movement
- Deep shoulder pain
- Clicking or catching
- Reduced confidence during sports
Associated Injuries
A Hill-Sachs lesion frequently occurs together with:
- Bankart tear
- Shoulder labral tear
- Glenoid bone loss
- Shoulder instability
- Rotator cuff tear (particularly in older patients)
These associated injuries are often more important than the Hill-Sachs lesion itself when determining treatment.
How is a Hill-Sachs Lesion Diagnosed?
Diagnosis begins with a history of shoulder dislocation or instability followed by a physical examination.
Your orthopaedic surgeon will assess:
- Previous dislocations
- Shoulder stability
- Range of motion
- Muscle strength
- Sporting activities
Imaging
X-rays
X-rays may identify moderate or large Hill-Sachs lesions after a shoulder dislocation.
MRI
MRI provides detailed assessment of:
- The Hill-Sachs lesion
- Labral tears
- Rotator cuff injuries
- Cartilage damage
MRI is particularly useful for evaluating associated soft tissue injuries.
CT Scan
CT provides the most accurate assessment of:
- Size of the Hill-Sachs lesion
- Glenoid bone loss
- Three-dimensional bone anatomy
CT is commonly used when surgical planning is required.
What is an “Engaging” Hill-Sachs Lesion?
Not all Hill-Sachs lesions behave the same way.
Some lesions are positioned so that they catch against the edge of the shoulder socket during movement. This is known as an engaging Hill-Sachs lesion.
An engaging lesion is more likely to contribute to recurrent instability and may influence the choice of surgical procedure.
Today, surgeons often assess this using the concept of the glenoid track, which considers both the Hill-Sachs lesion and any bone loss from the shoulder socket. This helps determine whether the defect is likely to contribute to instability and guides treatment planning.
Non-Surgical Treatment
Many patients with small Hill-Sachs lesions do not require surgery.
Treatment may include:
- Sling after dislocation
- Physiotherapy
- Rotator cuff strengthening
- Scapular stabilisation exercises
- Gradual return to sport
Management focuses on restoring shoulder stability rather than treating the bone defect itself.
When is Surgery Recommended?
Surgery may be considered when there is:
- Recurrent shoulder instability
- A large or engaging Hill-Sachs lesion
- Significant glenoid bone loss
- Associated Bankart tear
- High-demand sporting activities
- Failure of non-surgical treatment
The decision is based on the overall pattern of instability rather than the Hill-Sachs lesion alone.
Surgical Treatment
The most appropriate procedure depends on the underlying cause of instability.
Options may include:
- Arthroscopic Bankart repair
- Remplissage procedure
- Arthroscopic capsular repair
- Latarjet procedure (when significant glenoid bone loss is present)
- Other bone reconstruction procedures in selected cases
Your surgeon will recommend the treatment most appropriate for your injury pattern and activity level.
Recovery
Recovery depends on the procedure performed.
Typical recovery includes:
| Activity | Approximate Time |
|---|---|
| Sling | 3–6 weeks |
| Physiotherapy | Begins early |
| Office work | 1–2 weeks |
| Driving | 4–6 weeks |
| Strengthening | 8–12 weeks |
| Return to contact sports | 4–6 months |
Frequently Asked Questions
Is a Hill-Sachs lesion a fracture?
A Hill-Sachs lesion is a type of compression injury to the bone that occurs during a shoulder dislocation. It differs from the typical fractures that most people think of, as it results from the humeral head impacting the edge of the shoulder socket.
Does every Hill-Sachs lesion need surgery?
No. Many small lesions do not require surgery. Treatment depends on whether the lesion contributes to recurrent instability and whether other injuries are present.
Can a Hill-Sachs lesion heal?
The indentation in the bone usually remains. Many people, however, regain excellent shoulder function because treatment focuses on restoring shoulder stability rather than repairing the defect itself.
What is a remplissage procedure?
A remplissage procedure is an arthroscopic technique used in selected patients with an engaging Hill-Sachs lesion. It helps reduce the risk of recurrent instability by preventing the defect from catching on the edge of the shoulder socket. It is not required for every Hill-Sachs lesion.
Why Choose Dr Puah Ken Lee?
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore with a practice focused on shoulder, elbow and sports injuries. He has extensive experience managing shoulder instability and associated injuries, including Bankart tears, Hill-Sachs lesions and bone loss. Treatment recommendations are individualised based on your symptoms, examination findings, imaging and activity level.
Related Conditions
- Shoulder Instability
- Shoulder Dislocation
- Bankart Tear
- Shoulder Labral Tear
- SLAP Tear
- Posterior Shoulder Instability
- First Orthopaedic Consultation
- Arthroscopic Bankart Repair
- Arthroscopic Latarjet
- Rotator Cuff Tear
- Shoulder Pain
- Shoulder Surgery
- Sports Injuries
- Return to Sport After Injury
For a full overview of shoulder conditions, visit Shoulder Specialist Singapore
Dr Puah is regularly invited to teach shoulder surgery internationally
Specialist Care for Shoulder Injuries in Singapore
Dr Puah is an orthopaedic surgeon specialising in shoulder, elbow and sports injuries. He provides personalised care tailored to each patient’s condition and activity level.
Consultations are available at Mount Elizabeth Novena.
If you are experiencing shoulder pain that is affecting your daily life or sports, early assessment can help guide appropriate treatment.
Book a consultation or contact the clinic to discuss your condition.
Book a Consultation
Book a consultation or contact the clinic via WhatsApp to get started
Book a consultation at 360 Orthopaedics, Mount Elizabeth Novena
Shoulder instability is common but treatable. Early diagnosis and appropriate management can improve outcomes and prevent long-term problems.
Dr Puah Ken Lee is an orthopaedic surgeon in Singapore specialising in shoulder, elbow and sports injuries at 360 Orthopaedics, Mount Elizabeth Novena. Patients with persistent shoulder pain or instability are encouraged to seek specialist evaluation.