A Bankart lesion is an injury affecting the shoulder joint. It involves damage to the ring of cartilage that surrounds the shoulder socket, often leading to instability. This is a common injury, especially for active individuals or athletes. Addressing a Bankart lesion is important for restoring normal shoulder function and preventing further complications.
Understanding the Injury
The shoulder is a ball-and-socket joint, where the rounded end of the upper arm bone (humerus) fits into a shallow socket on the shoulder blade, known as the glenoid. To increase the depth and stability of this shallow socket, a rim of fibrocartilage, called the glenoid labrum, encircles its edge. The labrum functions as a static stabilizer, deepening the socket and helping to resist excessive movement of the humeral head, preventing dislocations.
A Bankart lesion refers to a tear or detachment of this glenoid labrum from the front, lower part of the shoulder socket. This type of tear compromises the joint’s structural integrity, making it more susceptible to instability. The injury can create a “pocket” at the front of the glenoid, allowing the humeral head to dislocate more easily.
Causes and Symptoms
Bankart lesions result from traumatic events, such as anterior shoulder dislocations. When the humeral head is forcefully pushed out of the shoulder socket, it can tear the labrum from its attachment to the glenoid. This often occurs during sports activities, falls onto an outstretched arm, or high-energy trauma like car accidents.
Individuals with a Bankart lesion experience symptoms such as pain in the front of the shoulder, often worsening with movement or overhead activities. A sensation of the shoulder “slipping” or feeling loose, known as instability, is common. Patients may also report a catching, clicking, or popping sensation within the joint, along with a decreased range of motion.
Diagnosis
Diagnosing a Bankart lesion involves assessment by healthcare professionals. The process begins with a patient history, where the individual describes the injury mechanism and their symptoms. A physical examination follows, during which the doctor assesses shoulder stability, range of motion, and specific movements that elicit pain or apprehension.
X-rays are performed to rule out bone fractures or bony Bankart lesions, but they do not directly visualize soft tissue injuries like labral tears. Magnetic Resonance Imaging (MRI) is the primary imaging study for confirming a Bankart lesion. MRI provides detailed images of the soft tissues, allowing for clear visualization of the labral tear.
Treatment Approaches
Treatment for a Bankart lesion can involve non-surgical or surgical methods, depending on factors like the patient’s age, activity level, and the severity of the labral tear. Conservative management is the initial approach, especially for less severe injuries or in older patients. This includes rest and immobilization using a sling to allow inflammation to subside.
Pain management strategies, such as oral analgesics or anti-inflammatory medications, alleviate discomfort. Physical therapy is a key component of non-surgical treatment, focusing on exercises to restore range of motion, strengthen the rotator cuff muscles, and improve shoulder stability. This rehabilitation aims to compensate for the compromised labrum through muscular control.
When conservative measures are insufficient or for individuals, especially younger, active patients, who experience recurrent shoulder instability, surgical repair is recommended. The most common surgical procedure is arthroscopic Bankart repair, a minimally invasive technique. During this procedure, the surgeon reattaches the torn labrum back to the glenoid bone using small incisions, an arthroscope (a thin camera), and specialized instruments.
Rehabilitation and Outlook
Rehabilitation is an important part of recovery following a Bankart lesion, particularly after surgical repair. Immediately after surgery, the shoulder is immobilized in a sling for several weeks to protect healing tissues. Physical therapy begins shortly after surgery, focusing on pain control and gentle, passive range of motion exercises to prevent stiffness.
As healing progresses, the rehabilitation program advances to active assisted and then active exercises aimed at restoring full range of motion and strengthening the shoulder muscles. The recovery timeline varies, but it takes 4 to 6 months to regain significant function, with full recovery extending up to a year. Return to strenuous activities, especially contact sports, is restricted for at least 6 months post-surgery to ensure healing and reduce the risk of re-injury.
The long-term outlook for individuals with a Bankart lesion, especially after successful surgical repair and adherence to rehabilitation, is favorable, with many able to return to their previous activity levels. While surgery aims to restore stability and reduce the risk of recurrent dislocations, a small percentage of patients may still experience re-dislocation or develop some degree of arthritis over time. Consistent participation in rehabilitation and adherence to activity restrictions contribute to good long-term outcomes and minimizing recurrence.