A Bankart Lesion is one of the more common forms of instability in the shoulder. This injury is damage to the anterior labrum of the shoulder. This is due to the stresses placed on the front of the shoulder due to overhead activities. The lesions can also be in the back or posterior part of the shoulder. Injuries to the posterior labrum are known as either posterior labral or Reverse Bankart lesions. The picture to the left is a depiction of a Bankart Lesion. If you thought of the labrum as a clock face, these injuries would occur from about 2 o’clock to 5 o’clock. The injury shown on the picture to the left is at around 4 o’clock on a right shoulder.
Symptoms of a Bankart Lesion
Many times, the athlete with instability will have a feeling that the shoulder wants to “come out of socket”. This is the shoulder slipping or sliding forward on the glenoid and into the labrum. Typically, the person will feel this “slipping” when they have the shoulder in what is known as the provocative position. This is the position that they would be in if the arm was cocked and ready to throw a ball. As the athlete continues to throw, the tear can increase and sooner rather than later, the athlete can no longer perform at their desired level. At this point, they will more than likely decide to have the shoulder repaired surgically.
How do you develop instability?
The most common way to develop anterior instability is shoulder dislocation(s). You can also develop instability just through the act of throwing or other overhead activities and weight lifting improperly. Throwing or serving a tennis ball, etc stresses the structures on the front of the shoulder. Over time, this can lead to the labrum detaching from the glenoid.
Diagnosing Anterior Instability
Anterior Instability is diagnosed with a thorough medical history and evaluation. Diagnostic tests such as X-ray and or MRI can and usually are utilized as well. X-rays will be taken to look for any fractures or bony abnormalities. The most effective way to evaluate the soft tissues of the shoulder is with an MRI. It is important to note that a contrast medium should be injected into the joint to ensure that any soft tissues can be seen. In the MRI picture, you see the shoulder if you were looking at it from a bird’s eye view. The red circle shows where the labrum has “come off” the glenoid. The white that you see between the bone and the glenoid is that of the contrast medium. Dependant upon how many cuts (the individual pictures of those views on the MRI) that the labral tear is seen in, shows Dr. Lowe how much of the labrum is involved and how to best deal with the injury.
If surgery is decided upon, the labral tear can be repaired through the arthroscope. First, Dr. Lowe will evaluate the shoulder while the patient is under anesthesia. Next he will look at all of the structures of the shoulder to asses the damage and how to best repair the injury. The surgery is usually accomplished arthroscopically using suture anchors. Suture Anchors are devices that are secured into the glenoid. They have sutures attached to them that allow Dr. Lowe to secure the tissue back to bone. The first picture shows a normal anterior labrum, the second is that of a torn labrum. Finally, the last picture shows after the repair is done.
Below is an illustration of how the labral tear is repaired surgically.
The rehabilitation following Bankart repair is just as important as the surgery itself. Typically following this procedure, the patient is in a sling with a wedge attached to keep the arm away from the side. This is to be worn at all times for the first month or longer following the procedure. Also following the surgery, the patient will begin formal physical therapy. Initially the therapy will consist of the therapist moving the shoulder for the patient. This is done to prevent the shoulder from becoming stiff, but done in such a way to protect the repair. After the appropriate period of time, the patient will then be allowed to come out of the sling and slowly begin doing more active work with the shoulder. Return to activities such as throwing and lifting weights is determined by Dr. Lowe on a patient to patient basis. To get a better idea of what is involved in the rehabilitation process, you can view the protocols that are on this site.