Have you ever dislocated your shoulder? Or have you ever fallen while playing sports and had severe pain in your shoulder that made it impossible to move your arm? Perhaps you too would like to know about a condition called a Bankart Lesion. Let's talk about it simply and politely.
What is this Bankart Lesion?
Simply put, a Bankart tear is an injury to the connective tissue that helps hold your shoulder in place, the socket, at the joint of your shoulder. This happens when your shoulder is pushed forward and sideways out of its socket, damaging that tissue.
Let's take a look at the shape of the shoulder?
Your shoulder is a joint formed by the upper round part of the large bone in your upper arm (the humerus) fitting into a socket in your shoulder blade (the scapula). This socket is surrounded by a ring of cartilage. This is what provides good support and stability to the shoulder joint.
This ring of cartilage is what we call the `Glenoid Labrum` . Now imagine, what would happen if your shoulder bone came out of that socket and hit this glenoid labrum? Then this labrum could tear, or it could even come off the bone. This is what we call a Bankart Lesion.
A doctor can put your dislocated shoulder back in place. However, this will not heal the Bankart injury. This is a long-term injury that makes your shoulder joint unstable, which means you are more likely to dislocate your shoulder again.
How common is this injury?
A shoulder dislocation is a very common shoulder injury. It affects about 1% of the population. About 90% of shoulder dislocations are anterior dislocations, meaning the bone is pushed forward through the socket.
This is where the glenoid labrum is most likely to be damaged when the shoulder is thrown forward. In fact, between 87% and 100% of such throws result in damage to this labrum. So, if you have dislocated your shoulder, you are very likely to have a Bankart tear.
What is a Bony Bankart Lesion?
Your doctor may say you have a 'bony Bankart lesion'. This means that both your glenoid labrum and the bone in the shoulder socket (the glenoid) have been damaged. This means that the tissue has been torn and the bone has been fractured or a small piece has come off.
These osseous Bankart lesions are less common than fibrous Bankart lesions, which only damage the labrum. However, they are seen in about 73% of cases of anterior shoulder dislocations.
What causes this?
A Bankart tear or glenoid labrum tear is when the bone in your shoulder dislocates and the supporting tissue around it tears. A dislocated shoulder is a traumatic injury that occurs when a large amount of force is applied.
There are several main reasons for this:
- Car accidents: Like when you get hit by a car.
- Sports accidents: It can happen to the shoulder when you dive and fall while playing cricket, or when you play rugby or volleyball.
- Falls: If you fall from a height or slip and fall, you can sprain your shoulder.
Imagine, you were riding your bike and suddenly braked and fell, hitting your shoulder and you could fall. Or, what if you slipped off a chair while doing housework and hit your shoulder? Things like that can cause this injury.
What are the symptoms?
You may experience symptoms like these with a Bankart lesion:
- Shoulder pain: You may feel pain throughout your shoulder, or you may feel pain in the front and bottom of your shoulder socket. See if this pain persists and doesn't go away with rest.
- Limited range of motion: Some shoulder movements, such as raising your arm, throwing something, or reaching for something overhead, may be difficult. Some people may also have difficulty putting on clothes or fastening their car seat belts.
- Mechanical symptoms: When the shoulder joint is moved in a certain way, there may be a "cracking" sound or a grinding sensation . Sometimes, the bone may feel like it is getting caught and then there may be pain.
- Shoulder instability: You may feel like your shoulder joint is loose, or the bone seems to move too much when you rotate your shoulder. You may even dislocate your shoulder.
"A friend of mine went to play cricket and drove and dislocated his shoulder. The doctor put the shoulder back in, but for a while afterwards he couldn't bowl or lift anything. They said it was just a loose shoulder. It was only later that I found out it was a Bankart injury."
How do you recognize this exactly?
A doctor will first ask you about the shoulder injury – when it happened, how it happened, whether it has happened before, etc. Then they will examine the shoulder joint to see if there is any instability.
Then, imaging tests are done to look at the injury. This usually includes an X-ray and an MRI (Magnetic Resonance Imaging) scan. The doctor wants to see how much damage has been done to the glenoid labrum and whether there are any other injuries. An MRI scan can clearly see this kind of soft tissue damage.
Do Bankart lesions always require surgery?
Not all glenoid labrum tears require surgery. But some do. Bankart tears can sometimes heal on their own, but they may not heal as well as they would with surgery. Your doctor may recommend surgery if:
- If your glenoid labrum has completely detached from the bone, surgery will be needed to reattach it to the bone.
- If you have a bony Bankart lesion and part of the bone has come off.
- If your shoulder is constantly unstable due to a previous injury and you frequently jump.
- If the shoulder joint is very important to your daily activities or the job you do (for example, as an athlete or carpenter).
What happens if left untreated?
Bankart lesions can heal without treatment, but they don't always heal properly. Sometimes the shoulder joint can remain unstable. This increases the risk of re-dislocation and further labral tears.
Your doctor can best tell you whether your injury will heal well on its own. Even if you don't have surgery, you need to take good care of your shoulder joint to ensure that it heals well.
How can this wound be healed with surgery?
During Bankart fracture surgery, dead or damaged tissue is removed and the tear is repaired with healthy tissue. If necessary, the surgeon will reattach your glenoid labrum to the glenoid bone.
To do this, surgeons attach small anchors to the bone in the socket, and suture the glenoid labrum tissue to the anchors. Then, the sutures are carefully tightened to stabilize the joint. This is sometimes called a Bankart Repair .
Arthroscopy method
Most often, surgeons can perform this Bankart repair using a shoulder arthroscopy . This means making a small incision, inserting a small tube with a camera (an `arthroscope`) through it, and performing the surgery through that tube.
Minimally invasive surgery methods like these can shorten recovery times and make recovery easier. However, for some serious injuries, open shoulder surgery may be necessary to properly heal.
How is the rehabilitation process?
Whether you have surgery or not, your shoulder will need both rest and rehabilitation to heal. This means you will need to wear a sling to immobilize your shoulder for several weeks. After that, you will need physical therapy .
A physical therapist will give you a series of exercises. These will be done gradually to rebuild muscle strength and range of motion. This will help stabilize the joint and reduce the risk of re-injury. It is very important to do these physical therapy exercises exactly as they are prescribed.
What is the outlook with this injury?
You may or may not need surgery for a Bankart lesion. However, the outlook is usually good. Most people recover well from a Bankart lesion. However, it can take up to six months for full recovery.
The biggest risk after recovery is that the shoulder instability will continue, causing the shoulder to dislocate again and the labrum to tear. This risk is reduced if you have surgery and do physical therapy properly.
What is the difference between a Bankart lesion and a Hill-Sachs lesion?
A Hill-Sachs lesion and a Bankart lesion can both occur for the same reason, often at the same time. When your shoulder bone snaps hard, it hits the rim of the shoulder socket.
This can tear the cartilage around the socket (your glenoid labrum). This is called a Bankart lesion. This injury can also damage the shoulder bone itself, causing a dent in it. This is called a Hill-Sachs defect or lesion.
What is the difference between a Bankart lesion and a SLAP tear?
A SLAP tear is another type of tear in the glenoid labrum. This occurs in the upper part of the labrum, from front to back. The word SLAP comes from the abbreviation Superior Labrum Anterior to Posterior .
This type of tear is less likely to be caused by a shoulder injury. Instead, it is most often caused by a forceful movement of the shoulder. It can happen suddenly, or it can happen gradually over time as a result of repetitive strain. Think of it like a volleyball player repeatedly jumping and hitting.
The symptoms and potential complications of Bankart lesions and slap tears are very similar. Both can cause instability of the shoulder joint, causing pain and an increased risk of dislocation. Both may require surgery.
If you don't remember dislocating your shoulder, and you feel pain above your shoulder socket, you most likely have a slap tear. If the pain is in the front and bottom, it could be a Bankart tear.
Finally, things to remember
If you dislocate your shoulder, it's likely that you've also torn your glenoid labrum. This injury can have far-reaching effects beyond the shoulder dislocation. In some cases, you may need surgery to repair it.
Healing from a Bankart injury takes time and effort. It can take months of physical therapy. However, many people, even athletes, who complete this program successfully regain full function in their shoulder. So, don't panic and follow your doctor's instructions. I wish you a speedy recovery!
` Shoulder dislocation, Bankart lesion, Glenoid labrum, Shoulder pain, Shoulder surgery, Physical therapy, Sports injuries
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