Bankart Lesions Guide

Bankart Lesions: A Detailed Overview

A Bankart lesion is the name for a tear that happens in the lower rim of the labrum and a common complication following a dislocation of the shoulder. This injury causes generalised shoulder pain and the signs and symptoms of recurrent shoulder instability. A shoulder specialist will diagnose this injury after a thorough investigation, as it can present with similar symptoms to shoulder conditions including Rotator Cuff Tears, shoulder impingement and SLAP lesions.

What is a Bankart lesion?

A Bankart lesion is a specific type of shoulder injury that occurs when the labrum, the rim of cartilage surrounding the shoulder socket (glenoid), is torn. Sports where this injury is more likely to occur are overhead sports or contact sports.

This injury typically involves the detachment of the anterior (front) part of the labrum, which can lead to shoulder instability. The labrum plays a crucial role in stabilising the shoulder joint, and a tear can significantly compromise its function, often resulting in repeated shoulder dislocations.

What types of Bankart lesions are there?

Bankart lesions are generally categorised into two types: soft Bankart lesions and bony Bankart lesions. A soft Bankart lesion refers to a tear of the labrum without any associated bone injury. In contrast, a bony Bankart lesion occurs when the labral tear is accompanied by a fracture or chip of the glenoid bone. Both types can lead to similar symptoms and issues with shoulder stability, but the presence of a bone fragment in bony Bankart lesions can complicate the treatment and recovery process.

What causes Bankart lesions?

Bankart lesions are mainly caused by trauma or injury to the shoulder, often resulting from a dislocation. The most common scenario involves a forceful impact or fall onto an outstretched arm, which can cause the shoulder to dislocate anteriorly (forward) and tear the labrum. Athletes participating in contact sports such as rugby, football, or hockey are particularly at risk.

Additionally, activities that involve repetitive overhead movements, like throwing sports or swimming, can also predispose individuals to this type of injury. In some cases, people with naturally loose or hypermobile joints may be more susceptible to developing Bankart lesions.

What are the symptoms of Bankart lesions?

The symptoms of a Bankart lesion often include a sensation of shoulder instability or repeated dislocations, particularly during activities that place stress on the shoulder joint. Patients may also experience pain, especially during overhead movements or when the arm is in certain positions. A feeling of weakness or giving way in the shoulder can occur, along with a clicking or popping sensation. Swelling and reduced range of motion are other common symptoms, impacting the ability to perform everyday tasks or participate in sports.

How are Bankart lesions diagnosed?

In your consultation, your London Shoulder Specialist will carry out a physical examination, assessing the range of motion and stability of the shoulder, often using specific manoeuvres to elicit symptoms. They will also discuss medical history including any sporting injuries leading up to it.

Imaging studies may be organised for confirming the diagnosis. An MRI is commonly used to visualise the soft tissues and detect any labral tears. In some cases, an MRI arthrogram, which involves injecting contrast dye into the shoulder joint, may provide more detailed images. X-rays can also be helpful to check for associated bone injuries, particularly in cases of suspected bony Bankart lesions. Sometimes X-rays can show an injury to the humerus called a Hill-Sachs lesion.

What are the treatment options for Bankart lesions?

The treatment of Bankart lesions depends on the severity of the injury and the patient’s activity level. Non-surgical options are typically considered first. These treatments include rest, physical therapy, and anti-inflammatory medications to manage pain and swelling. Physical therapy focuses on strengthening the shoulder muscles and improving stability to compensate for the damaged labrum.

If non-surgical treatments fail to provide relief or if the patient experiences recurrent shoulder dislocations, surgical intervention may be necessary. The goal of surgery is to reattach the torn labrum to the glenoid, restoring stability to the shoulder joint.

What does Bankart lesion surgery involve?

Bankart lesion surgery is typically performed arthroscopically, which is a minimally invasive technique. During the procedure, small incisions are made around the shoulder, and an arthroscope (a small camera) is inserted to provide a clear view of the joint. The surgeon then uses specialised instruments to reattach the torn labrum to the bone using anchors and sutures. In cases of bony Bankart lesions, the surgeon may also address any bone fragments or repair the glenoid bone as needed. Arthroscopic surgery is preferred due to its less invasive nature, resulting in smaller incisions, less pain, and quicker recovery times compared to open surgery.

What does rehabilitation after Bankart lesion surgery involve?

Rehabilitation following Bankart lesion surgery is crucial for a successful recovery and return to normal activities. The rehabialitation process is typically divided into several phases. Initially, the focus is on protecting the repaired labrum and allowing it to heal, which involves wearing a sling for several weeks to immobilise the shoulder. During this period, passive range-of-motion exercises are introduced to prevent stiffness.

As healing progresses, physical therapy emphasises gradually increasing the range of motion and strengthening the shoulder muscles. Exercises are tailored for the individual to improve stability and prevent future dislocations. The final phase of rehabilitation involves more dynamic and sport-specific exercises to restore full function and ensure the shoulder can handle the demands of daily activities or sports participation. Overall, the rehabilitation process will take around six months.

If you suspect that you may have Bankart lesions, speak to your London Shoulder Specialist who can recommend an appropriate treatment plan and ways to effectively manage your condition.