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Engaging Hill‐Sachs lesions can be a factor predictive of recurrent anterior shoulder instability, yet no method has been recognized as an effective means to predict engagement. We evaluated the ability of sonography to identify engaging Hill‐Sachs lesions by using a transaxillary approach and dynamic scanning. In patients with engaging lesions, there was an abrupt change in the contour of the humeral head when the shoulder was in 90° of abduction and 90° of external rotation. Sonography therefore has the potential to be a useful preoperative tool in determining which patients may benefit from a surgical repair that also addresses Hill‐Sachs lesions.

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