Bankart Lesion
Bankart lesions happen in a part of the shoulder, causing pain, instability, and weakness. The injury is common in contact sports, although it can happen in many other ways.
Take a closer look at the condition and learn about the treatment we offer at Sports Med London.
The Glenoid Labrum
The glenoid labrum is the only part of the body in which Bankart lesions occur. The fibro-cartilaginous structure is rubbery, and it surrounds the glenoid cavity to form a deeper socket and to stabilise the joint. The glenoid labrum is something like a washer in a tap, as it seals the joint’s two sides.
A Closer Look At Bankart Lesion
A Bankart lesion occurs when part of the glenoid labrum tears, which often happens during shoulder dislocations. The anteroinferior labrum detaches between the 3 o’clock and 6 o’clock position. If part of the glenoid bone breaks off when the tear happens, the injury is called a bony Bankart lesion.
Sports injuries such as rugby tackles and other high energy trauma such as car accidents are common causes of Bankart lesions. The repetitive arm movements made by gymnasts, swimmers, tennis players, and weightlifters, and landing on the shoulder after falling are other causes of the condition.
Bankart lesion can happen to people of any age, but those in their twenties are most at risk.
Symptoms Of Bankart Lesion
The most common symptoms of Bankart lesion include:
- Pain during daily activities
- Pain when reaching overhead or throwing a ball
- Pain when you lie on the affected side
- Should instability and weakness
- Limited range of motion in your shoulder
- Catching or grinding sensations or a popping sound in the shoulder
Diagnosing And Treating Bankart Lesion
Our specialists base Bankart lesion diagnosis on your description of how the injury happened and on a physical examination of your shoulder. If they suspect there may be other problems with your shoulder, they may send you for an MRI scan or a scan that uses dye for contrast, such as an MR arthrogram or a CT arthrogram.
Non-surgical treatment of Bankart lesions usually is limited to physiotherapy. However, non-surgical treatment of the condition in younger patients or those involved in collision contact sports or other activities that see the arm lifted sideways away from the torso and twisted so that the forearm is vertical can lead to recurring instability or dislocations.
When surgical treatment is performed, it usually takes the form of keyhole (arthroscopic) labrum repair, also known as arthroscopic Bankart repair or anterior shoulder stabilisation. If the injury is a bony Bankart lesion, surgery may be keyhole or open, and it will involve either repairing or replacing the damaged bone. A tailored physiotherapy programme follows the surgery. You may also need to wear a sling for a few days after surgery.
Technical Information:
What is a Bankart Lesion (tear)?
A Bankart lesion is a tear of the anterior glenoid labrum (rim surrounding the socket) associated with anterior shoulder dislocations. In a Bankart lesion there is detachment of the anteroinferior labrum (typically at the 3 o’clock to 6 o’clock position). If the lesion is associated with bone detachment, it is called a bony Bankart lesion when some of the glenoid bone is broken off with the anterior labrum. A bony Bankart potentially leaves the shoulder joint more unstable due to the loss of the labrum and the loss of bone.
How does a Bankart Lesion (tear) occur?
Bankart lesions are injuries associated with people who have had a shoulder dislocation and sustained a particular type of labrum injury as a result. Bankart lesions are frequently the result of high energy trauma or sports injuries and can be acute injuries such as a sports collision (rugby tackle) or in a car accident where the impact forces or pulls the shoulder out of alignment causing a dislocation. They can occur due to repetitive arm motions for example in swimmers, tennis players, gymnasts and weight lifters resulting in anterior instability. Bankart lesions can also be sustained by falling and landing on one’s shoulder with enough force to dislocate the shoulder such as a fall from a ladder or tripping over and landing on a hard surface.
Though anyone can sustain this injury, young people in their twenties are most susceptible.
How is a Bankart Lesion diagnosed?
This is based on the mechanism of injury and a careful clinical examination. The surgeon may request a standard MRI scan or sometimes request a special scan with contrast (dye) in the joint such as an MR arthrogram or CT arthrogram.
How is a Bankart Lesion treated? Surgical vs Non-Surgical Management
This can be treated conservatively through physiotherapy however in younger patient groups and those involved in collision contact sports or activities where the arm is frequently abducted and externally rotated (lifted sideways away from the torso twisted such that the forearm is pointing vertically) are at risk of recurrent episodes of dislocation or instability. In such cases often an arthroscopic (keyhole) repair of the labrum is performed which stabilises the shoulder. This is called an arthroscopic Bankart repair or anterior shoulder stabilisation.
How is a Bony Bankart lesion treated?
If a small portion of the anterior glenoid is fractured along with the anterior labral tear this is referred to as a Bony Bankart Lesion. The joint is significantly less stable and usually requires early surgical fixation. Depending on the size of the bone fragment the procedure may be performed arthroscopically or for larger fragments through a small anterior incision and either fixing the bone fragment or replacing it with a block of bone.
Post-operatively the shoulder will be immobilised and protected in a sling usually for about 4-6 weeks but depending on the extent of the tear or associated fracture the surgeon may decide to continue with this for longer.
Following surgery a tailored rehabilitation programme with physiotherapy is commenced to help you return to your normal day to day activities. The progress of this is dictated by patients meeting milestones and is run under the supervision of the surgeon and specially trained physiotherapist.