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Reverse Hill-Sachs Lesion (Posterior Shoulder Dislocation Injury)

A reverse Hill-Sachs lesion is a dent or compression fracture in the front of the humeral head (shoulder ball) caused by posterior shoulder dislocation, where the shoulder ball jams against the back of the socket creating a permanent divot - it's much less common than regular Hill-Sachs lesions (from anterior dislocations) and may cause recurrent posterior instability requiring surgical repair if the defect involves more than 25% of the joint surface.

📅Last reviewed: January 2026đŸĨBones & Joints

📖What is Reverse Hill-Sachs Lesion (Posterior Shoulder Dislocation Injury)?

A reverse Hill-Sachs lesion is a dent or compression fracture in the front of the humeral head (shoulder ball) caused by posterior shoulder dislocation, where the shoulder ball jams against the back of the socket creating a permanent divot - it's much less common than regular Hill-Sachs lesions (from anterior dislocations) and may cause recurrent posterior instability requiring surgical repair if the defect involves more than 25% of the joint surface.

đŸ”ŦWhat Causes It?

  • Posterior shoulder dislocation causing front of humeral head to impact against back of glenoid (socket), creating compression fracture
  • Seizure activity (epilepsy, alcohol withdrawal) causing forceful muscle contractions that dislocate shoulder posteriorly
  • Electric shock injury (lightning, electrocution) with violent muscle contractions
  • High-energy trauma (car accident, fall from height) forcing shoulder backward

âš ī¸Risk Factors

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You may be at higher risk if:

  • Seizure disorder (epilepsy - 30-50% of posterior dislocations occur during seizures)
  • Alcohol misuse (withdrawal seizures leading to shoulder dislocation)
  • Electric shock exposure (occupational hazard for electricians, lineworkers)
  • Contact sports or high-energy activities (football, rugby, motor vehicle accidents)

đŸ›Ąī¸Prevention

  • ✓Manage seizure disorder with consistent anti-epileptic medications (reduces seizure frequency)
  • ✓Electrical safety precautions (circuit breakers, protective equipment for workers)
  • ✓Avoid alcohol misuse (withdrawal seizures are preventable cause of posterior dislocations)
  • ✓If first-time posterior dislocation treated, complete full physiotherapy program to strengthen posterior shoulder stabilizers