Shoulder dislocation , Hill Sachs Lesion - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describing shoulder dislocation, Hill-Sachs Lesion defect It explains shoulder dislocation reduction and treatment.also shoulder dislocation surgery is explained .
the shoulder dislocation animation is presented Bankart lesion is also shown .shoulder instability tests and examination and treatment is explained .
hill-Sachs lesion is a dent in the back of the humeral head, which occur during anterior shoulder dislocation, as the humeral head impact against the front of the glenoid cavity of the scapula.
This indentation of the posterior aspect of the humeral head occurs in up to 80% of recurrent anterior shoulder dislocations.
When a Hill-Sachs lesion is identified, it is important to do careful assessment of the anterior glenoid rim and labrum to identify a potential Bankart lesion.
The labrum is a rim of cartilage that attaches around the edge of the glenoid.
The glenoid labrum contributes to shoulder stability.
As the shoulder dislocates, the humeral head may tear part of the labrum away from the glenoid of the anterior inferior glenoid labrum due to anterior shoulder dislocation ¡s called a Bankart Lesion.
Bankart lesions cause chronic instability of the shoulder and usually require surgery.
How big is the Hill-Sachs lesion?
The Hill-Sachs lesion can range from a small to large indentation and the size of the lesions the treatment the Patient.
The larger the Hill-Sachs lesion, the more likely that the shoulder will be unstable and the more likely to dislocate again (recurrent dislocations).
Thwe larger the Hill-Sachs lesion, the more likely that the glenoid labrum and joint capsule have a significant tear.
X-rays:
The defect may be missed on a routine AP view.
The axillary view is helpful for the subluxation or the dislocation, however; a combination of the AP view in internal rotation and a Striker Notch view will allow evaluation of the Hill-Sachs lesion that is present in the posterolateral aspect of the humeral head.
CT scan: It can be very helpful.
MRI: is the procedure of choice for labral pathology.
Treatment:
Small sized Hill-Sachs lesion, which is less than 20%, is usually treated nonoperatively.
Medium sized lesion: defect is usually more that 25%, arthroscopic or open remplissage procedure; it may be performed in combination with Bankart repair, the defect is filled with the posterior capsule and rotator cuff usually the infraspinatus.
Large sized lesion (rare): the lesion is greater than 40%, usually filled with bone or metal.
It should be noted that the normal humeral hear has a bare area on the posterior aspect, and it shouldn’t be confused with a Hill-Sachs lesion.
Hill-Sachs lesion is not clinically significant unless the defect engages the glenoid.
Engaging Hill-Sachs lesion:
When the lesion is large enough, and the arm is in abduction and external rotation, the shoulder will dislocate and the anterior glenoid will engage the posterior part of the humeral head.
Some surgeons consider doing open procedure with engaging Hill-Sachs lesion.
What is the difference between the Hill-Sachs lesion and the reverse Hill-Sachs lesion?
Hill-Sachs lesion occurs with anterior dislocation of the shoulder, it is indentation on the posterior aspect of the humeral head, following anterior shoulder dislocation, the posterior humeral head hits the anterior glenoid rim.
Reverse Hill-Sachs lesion is the indentation of the anteromedial aspect of the humeral head following posterior shoulder dislocation; anteromedial humeral head hits the posterior glenoid rim.

to see my detailed shoulder dislocation video ,copy and past this link
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