Bankart Lesions

Anatomy To fully understand Bankart lesions, we need to first understand the structure of the shoulder. The shoulder is a ball and socket joint, similar to the hip. The top of the arm bone (head of the humerus) forms the ball and the front part of the shoulder blade (glenoid fossa) forms the socket.

To allow for the large range of mobility that the shoulder needs to move the arm in multiple directions, the socket is very shallow. Imagine a golf ball sitting on top of a golf tee, not very stable. So, around the rim of the socket is a special band of cartilage known as the glenoid labrum. This is made of fibrocartilaginous material and works to deepen the socket to improve the connection of the joint and improving stability without restricting mobility.

Sometimes, however, a sudden shoulder injury or overuse can create a forceful dislocation that tears the cartilage and ligaments of the shoulder.

What is a Bankart Lesion? When you tear your glenoid labrum below the center anterior (front) of the socket, this is called a Bankart lesion. When the labrum is torn, the cartilage rim around the socket is compromised, allowing the humeral head to slip farther than normal.

Most Bankart lesions are caused by anterior dislocations — when the arm moves too far forward and down, often when the arm is extended to the side. This will be most likely be associated with a Hill Sachs Lesion as well. Hill-Sachs lesions are a posterolateral humeral head compression fracture. Posterior dislocation (when the arm is forced backwards) can also lead to a tear in the labrum, though less commonly – only 2 -3 % of dislocations are Posterior dislocations.

With anterior shoulder dislocations, as well as suffering from a labrum tear, in some cases, there may also be damage to one of the shoulder bones. Damage to the glenoid (the socket part) is known as a Bony Bankart. This is when there is a fracture (break) in the anteroinferior (lower front) part of the glenoid cavity, as well as a labrum tear.

Bankart lesions may also be associated with fractures of the head of humerus (the ball), such as a Hill-Sachs lesion, where there is a compression fracture on the posterolateral (outer back) part of the humeral head.

The joint capsule, a special sac that surrounds the glenohumeral joint, may also be damaged, as may be the surrounding ligaments, most commonly the inferior glenohumeral ligament.

These all increase the risk of further shoulder instability. An untreated Bankart lesion can lead to chronic shoulder instability — meaning your shoulder may dislocate again in the future, probably in situations involving less force than the original injury.

Causes of a Bankart Lesion

Bankart lesions are frequently the results of collisions, accidents, and sports injuries (either acute injuries or overuse injuries from repetitive arm motions). Though anyone can sustain this injury, young men in their twenties are most susceptible.

Possible causes of shoulder dislocations and lesions: • Car accidents. A sudden blow to the shoulder can knock the ball from its socket, tearing the labrum. • Sports collisions. Crashing into another person with speed and force — for example, during rugby or hockey when tackling or striking against someone — you can shove the shoulder out of alignment or drag the arm forward or backward, leading to dislocations. • Falls from sports. Falling and landing on one's shoulder can lead to shoulder dislocations in athletes, especially in sports where falling with height or speed is common, like gymnastics, rugby, skating, rollerblading, or skiing. • Falls not from sports. Falling off a ladder or tripping on a crack in the sidewalk can deliver enough force to dislocate the shoulder. Elderly people and those with gait problems can be highly susceptible to these types of falls. • Overuse injuries. In some athletes, overuse of the shoulder can lead to loose ligaments and instability. Swimmers, tennis players, volleyball players, gymnasts and weight lifters are prone to this problem. In addition, non-athletes may develop instability from repeated overhead motions of the arm (for example, swinging a hammer). • Loose ligaments. Some people have a genetic predisposition to loose ligaments throughout the body (e.g., double-jointed individuals). They may find that their shoulders pop out of alignment easily. • Physical abuse. Domestic violence, physical bullying, or fighting can involve falls, blows, or sudden wrenching movements that may pull the ball from the socket, damaging surrounding tissue.

Signs and Symptoms of a Bankart Lesion

This type of labrum tear shares many symptoms with other shoulder injuries. A thorough doctor's exam is necessary to properly diagnose your symptoms.

Symptoms of a Bankart lesion can include:

• Pain. When reaching overhead, at night, or with daily activities. Throwing a ball may also cause pain. • Instability and weakness. The shoulder may "just hang there," pop out of the joint, or feel too loose. • Limited range of motion. Sudden difficulty moving the shoulder in any direction may indicate a tear. • Unusual noises or sensations in the shoulder. Grinding, catching (not moving fluidly), locking in place, or popping can all be symptoms of torn tissue getting caught in the joint.

Bankart Lesion Repair (Surgery) If your shoulder continues to dislocate or feel unstable, see a doctor to diagnose a Bankart lesion. Your doctor may use X-rays, Sonar, MRI and/or a thorough physical exam to confirm a tear and determine whether you also have a bony bankart lesion.

Depending on the cause of your shoulder instability (is it a traumatic injury, or a chronic condition that arose on its own?), surgery may be advised to stabilize the shoulder joint.

Surgical Treatment

Surgery tends to be the treatment of choice for younger patients with a Bankart lesion, especially those who play sports, as there is a high risk of the shoulder dislocating again. This is because the glenoid labrum tear often fails to heal properly, so doesn’t provide the extra depth to the socket that is needed, reducing the stability and increasing the risk of further dislocation.

A Bankart lesion repair is usually carried out arthroscopically (key hole surgery) under general anaesthetic. The labral tear surgery aims to repair and tighten overstretched and damaged ligaments, joint capsule and cartilage. Suture anchors are placed in the bone and the torn glenoid labrum is reattached to the glenoid fossa. You can usually go home the following day.

A sling will need to be worn (including when you sleep) to protect the shoulder for the first 6 weeks and allow it to heal in the correct position. Physical therapy will be started after 6 weeks to regain strength, stability and movement. You will be given a rehab programme to follow, progressing to more challenging exercises over time. It usually takes around 4-6 months to recover completely and be able to return to contact sports. Full healing in the body takes one year.

Bankart shoulder repair surgery has an approximately 85-90% success rate, with most people returning to their pre-injury activity levels. Outcome tends to be slightly better when surgery is carried out soon after the initial labrum tear, rather than further down the line.

Open surgery. In some cases, orthopaedics may prefer to use open surgery called a Latterjet. Which method your doctor chooses depends on variables like the type and location of your injury, the condition of your tissue, and how much additional damage you may have sustained.

If you are healthy, the outlook for shoulder surgery of this kind is generally good, with most patients resuming movement and non-contact sports within after 6 weeks. Most patients will need to avoid heavy lifting and impact activities for at least three to six months while they undergo physical therapy to regain strength and range of motion in the shoulder. Healing in the body takes one year.