Bankart Lesions

A Bankart lesion of the shoulder is a tear of the labrum that causes instability and recurrent dislocations of the shoulder joint. This type of injury often occurs when the shoulder pops out of joint, thereby tearing the labrum. This is quite common in younger patients.

Cause

A Bankart tear is a specific injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable.

Symptoms

When the labrum of the shoulder joint is torn, the stability of the shoulder joint may be compromised. A specific type of labral tear is called a Bankart tear. A Bankart tear occurs when an individual sustains a shoulder dislocation. As the shoulder pops out of joint, it often tears the labrum, especially in younger patients. The tear is to part of the labrum called the inferior glenohumeral ligament. When the inferior glenohumeral ligament is torn, this is called a Bankart tear.

Typical symptoms of a Bankart tear include:

• a sense of instability

• repeat dislocations

• catching sensations

• aching of the shoulder

Often patients will complain that they cannot trust their shoulder, fearing it may dislocate again.

Diagnosis

Most young patients (under the age of 30) who sustain a shoulder dislocation will sustain a Bankart tear; therefore, there is a high suspicion of this injury whenever a young patient dislocates their shoulder. On examination, patients will often have a sense their shoulder is about to dislocate if their arm is placed behind their head.

X-rays are sometimes normal, but they may show an injury to the bone called a Hill-Sachs lesion. This is a divot of bone that was injured when the shoulder dislocation occurred. An MRI may also be obtained in patients who have dislocated their shoulder. Bankart tears do not always show up well on MRI scans. When a MRI is performed with an injection of contrast solution, a Bankart tear is much more likely to be seen.

There are two general options for the treatment of a Bankart tear.

One option is to allow the arm to rest, and the inflammation to subside with the use of a sling. This is usually followed by physical therapy to regain motion of the extremity. The potential downside of this option is that people who dislocate a shoulder once are much more likely to dislocate the shoulder again.

Arthroscopy

The other option is to perform surgery to repair the torn labrum. This surgery can be performed arthroscopically.  When surgery is performed, the torn ligament is reattached to the socket of the shoulder.

The results of surgery are usually very good, with over 90% of patients returning to their activities without any further dislocations. More and more commonly this surgery is being performed arthroscopically; however, there are some patients who should have a Bankart repair performed through a standard incision.

Some orthopedic surgeons recommend surgery to repair a Bankart tear after an initial shoulder dislocation in young athletes. The usual treatment after a shoulder dislocation is a period of rest, followed by aggressive physical therapy, then a gradual return to activities. If the shoulder dislocates again, surgery is usually considered.

Some orthopedic surgeons will repair a Bankart tear after one dislocation in young athletes.

Because the chance of repeat dislocation is so high, especially in athletes who participate in contact sports, this type of immediate Bankart repair can be justified.

The concern of these surgeons, is that every time a shoulder dislocation occurs, damage can occur to the joint, including cartilage damage. Therefore, if there is a very high chance of repeat dislocation, then steps should be taken to prevent that from occurring.