REVERSE HILL-SACHS LESION IN A YOUNG PATIENT FOLLOWING INDIRECT TRAUMA OF THE LEFT SHOULDER: A CASE REPORT
G. Morici1, A. Gervasio1, E. Vanzetti1, G. Bragaglio2, S. Miglio2, F. Maffezzoni2, G. Carpeggiani3
1Department of Radiology, Clinical Institute, Città di Brescia, Brescia, Italy;
2Oberdan Specialist Outpatient Clinic, Via Guglielmo Oberdan 126, Brescia, Italy;
3Department of Orthopedics, Villa Maria Private Hospital, Padua, Italy
*Correspondence to:
Giulio Morici, MD
Department of Radiology,
Clinical Institute, Città di Brescia,
Brescia, Italy
e-mail: giulio.morici@yahoo.it
| Received: 13 March, 2026 Accepted: 16 April, 2026  |
ISSN 2975-044X (online) ISSN 2038-4106 (print) Copyright © by LAB PUBLISHERS 2026 This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article. |
ABSTRACT
The reverse Hill-Sachs lesion is an osteochondral depression involving the anteromedial aspect of the humeral head, typically resulting from posterior shoulder dislocation or subluxation. Early recognition is essential to prevent chronic instability and degenerative joint changes. A 28-year-old man presented with an indirect injury to the left shoulder sustained during extension and internal rotation against resistance. Clinically, he reported deep pain and limited external rotation, without evident deformity or signs of complete dislocation. MRI demonstrated a mild anteromedial humeral head impaction consistent with a small reverse Hill-Sachs lesion, associated with post-contusional bone marrow edema more pronounced at the lesser tuberosity. The rotator cuff was intact, with mild insertional inhomogeneity of the subscapularis tendon. The long head of the biceps tendon was intact and properly positioned. Mild inhomogeneity of the posterior glenoid labrum was noted, without joint effusion. The patient was managed conservatively with brief immobilization in a Desault brace, followed by targeted physiotherapy focused on restoring external rotation and strengthening the posterior rotator cuff and scapular stabilizers. In cases of minimal bone involvement (<20-25%) and stable post-reduction alignment, a conservative approach is supported by the literature. Parameters such as defect size and the gamma angle help guide therapeutic decision-making and predict the risk of engagement with the posterior glenoid rim. This case demonstrates that a small reverse Hill-Sachs lesion can be effectively treated conservatively, with excellent short-term clinical and radiological outcomes. Early diagnosis and multidisciplinary collaboration are crucial for achieving optimal functional recovery and preventing chronic posterior instability.
KEYWORDS: reverse Hill-Sachs, posterior shoulder dislocation, osteochondral defect, gamma angle, shoulder instability, conservative treatment, McLaughlin procedure, rotational osteotomy, shoulder arthroplasty, magnetic resonance imaging