This 1940 paper by Hill and Sachs defines the grooved posterolateral humeral head defect now known as the Hill-Sachs lesion. It reviews 119 shoulder dislocations plus prior literature to answer one question: is this defect a late degenerative change or a fracture sustained at the moment of dislocation?
When you see a grooved defect on the posterolateral humeral head after an anterior dislocation, this is the paper that named and explained it.
The mental model: arm abducted and internally rotated, head levered out against the anterior glenoid rim, soft posterolateral spongiosa crushed. The lesion is a fracture from the injury itself, not a late change. That means it can be present after the very first dislocation.
The practical pitfall the authors flag still applies. Routine external-rotation films hide the defect. Order an AP in marked internal rotation, and add a tangential view when you need to size it.
Large humeral head defects predicted failure of soft-tissue repair, especially when an anterior approach missed the lesion. This outcome lesson is the seed of the modern bone-loss concept in instability surgery.
This 1940 paper by Hill and Sachs defines the grooved posterolateral humeral head defect now known as the Hill-Sachs lesion. It reviews 119 shoulder dislocations plus prior literature to answer one question: is this defect a late degenerative change or a fracture sustained at the moment of dislocation?
When you see a grooved defect on the posterolateral humeral head after an anterior dislocation, this is the paper that named and explained it.
The mental model: arm abducted and internally rotated, head levered out against the anterior glenoid rim, soft posterolateral spongiosa crushed. The lesion is a fracture from the injury itself, not a late change. That means it can be present after the very first dislocation.
The practical pitfall the authors flag still applies. Routine external-rotation films hide the defect. Order an AP in marked internal rotation, and add a tangential view when you need to size it.
Large humeral head defects predicted failure of soft-tissue repair, especially when an anterior approach missed the lesion. This outcome lesson is the seed of the modern bone-loss concept in instability surgery.