Hill-Sachs lesion

Mar 2, 2009
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Anybody have any advice about surfing with a Hill-Sachs lesion? It’s fairly substantial and wasn’t present on a 2020 X-ray or MRI. It doesn’t give me much problems right now, but maybe there’s something I can right now do to reduce its growth. From my understanding, the HSL causes humeral head to just wear away. In my x-ray, the lower half of my shoulder ball (hah hah hah hah) is worn away in 3 years. It seems like at some point it will be excruciating & bad while surfing. I don’t want that. I’m also dealing with a labrum tear, but I know about that and can take care of it. And I also know at some point that shoulder will be replaced due to previous injuries and a lifetime spent snowboarding & surfing. I want to delay a shoulder replacement for a very long time. Anybody know about HSL? I’m doomed, aren’t I.

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Mr J

Michael Peterson status
Aug 18, 2003
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Regional Vic, Australia
I've got a hills-sachs in one shoulder and a reverse hills-sachs in the other (posterior dislocation). My understanding is that you didn't just acquire that from wear and tear, you dislocated it some time after 2020. The lesion (divot) occurs when the humerous chips itself against some other shoulder bone as it tries to go back into the socket. I'm not a medical professional so you should check this.

I'm just a patient extrapolating info from my health professions, so you need to check what I am about to say with your health professionals. So with a chunk missing from the ball of the humerous its going to be more prone to shifting out of perfect alignment with the socket and aquire wear. So the thing to do is to strengthen the rotator cuff muscles so that they exert plenty of pressure keeping the shoulder sitting properly in the socket. You would have been prescribed plenty of these I assume?

I'm doing rotator cuff exercises almost daily, I plan to continue indefinitely, its not some short term rehab thing for someone in my condition. I've also been taught how to move my shoulder "properly" to minimise it being pulled unevenly and to reduce the chances of the supraspinatus wearing out. Rounded shoulders and not lifting up the lateral end of my collarbone in the direction of my ear when overhead lifting (or paddling) constricts the narrow space in which the supraspinatus passes and its more likely to wear out. So I don't just paddle without thinking anymore - I can't be constantly monitoring my motions, but I always start a session paddling out with concentration and give myself periodic reminders. I've also been taught some shoulder blade flattening exercises - its too hard to concentrate on shoulder blade movement when I'm surfing along with everything else, but the hope is making it a habit on dry land will carry on subconsciously in the sea.

Paddling to exhaustion is also likely to lead to a situation where the muscles aren't working in perfect balance. So I limit sessions to about 1hr and take a rest day every couple of days.

I think you are taking a pessimistic attitude with your doomed statement. We are all mortal and therefore doomed. The trick is not to let one part wear get ruined much more quickly than all the other bits, while having as much risky fun as possible. I'm trying to manage risk now and the with extra attention to my damaged bits I'm hoping to keep it going as long as the good bits are still operating. The plus side is that my posture has had a further improvement from all these shoulder exercises. I'm also putting a lot of work into keeping my core strong. With a solid core I'm less likely to make silly mistakes when trying to do things such as a late takeoff. That's my reasoning anyway. I've got to look after my dodgy back anyway! its come good, but I don't take back health for granted. Of course its easy for me to say this because I'm currently able to surf a lot. If I was dry docked from some injury then I wouldn't be so optimistic. However, sounds like you aren't currently getting much trouble either.

So have you been told you are heading for a shoulder replacement, or just fearing the worst? What do you do to manage you labrum tear? As far as I know I don't have one, but I'm interested.
 
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Mar 2, 2009
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Thanks for the info, Mr J. Good luck with your shoulder. I’ll definitely incorporate your ideas into my PT.

My town is an orthopedist dream, but we got completely overrun during Covid and there’s no housing which equals no employees. Limited number of PT, but they’re all quality. The constant waiting for appointments has been brutal. 2 weeks for 1st appointment to assess & xray. Then 2 weeks for an MRI. Then 3 weeks just to read the fvcken MRI. Now I’ve been waiting 2 weeks for PT to get my info and call for an appointment. I called last week, but no news. I finally just drove over this afternoon and it was simply filed away. Turns out they don’t have appointments until January and they weren’t even going to call me. So I called my surgeon and said WTF. Her front desk suddenly found an appointment for me next week somewhere else. So I finally start PT.

The weird thing is that I’ve never dislocated my shoulder. Besides breaking the glenoid and tearing my labrum. Maybe I dislocated it into my socket. All that was fixed 11 years ago. Recovery was easy and I’ve always had super flexible shoulders that are aren’t loose at all. Even now.

Anyway, thanks again.
 
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Mar 2, 2009
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Oh and to answer your questions…
-yes, I’ve been told at some point I’ll need a new shoulder
-so far I’ve done nothing except cortisone for the labrum tear, waiting for PT to give me correct exercises.
-my rotator cuff is solid, strong, and undamaged.
-“doomed” to me is no surfing & no snowboarding, since it’s basically my thing
-I’ve had a hip replacement at 28 & revision at 42. Long story, but original problem wasn’t from an injury. I’m 53 now.
-I’m also trying to keep the body together despite a few injuries over the years. Specifically here, I’ve broken both shoulders at different times. My shoulders have always been tight, solid, flexible & strong before & after recoveries. Swimming through my 30’s & sporadically since has always kept them in alignment and strong.
-I used to live at the beach and surfed everyday there was even a bump in the Pacific. Now I’m landlocked in the winter, surf a month in Spring & a month in the Fall, with mountain biking and stretching in between.
-none of this adds up to Hills-Sachs except for the broken glenoid. That’s what’s confusing everything.
 
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