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Bankart Lesion Physiotherapy
A Bankart lesion (medically termed as a glenoid labrum tear), typically happens when the
shoulder dislocates anteriorly (forwards), and this ends up damaging the lower part of the special
cartilage that lines the shoulder socket.
Most of the time, it affects mainly young
Damage to the labrum makes the shoulder more risk to shoulder
instability and there is a high risk of further shoulder dislocation
without appropriate treatment.
Bankart lesions are named after
English orthopedic surgeon Dr Arthur Sydney Blundell Bankart, who lived between 1879-1951,
who first described the injury and the surgical repair process.
In this article we will look at the common causes, the associated injuries, the symptoms and the
treatment options, both surgical and non surgical, for a typical Bankart lesion
first of all...What Causes A Bankart Lesion?
To fully understand Bankart lesions, we need to first understand
the structure of the human shoulder.
Our shoulder is a ball and socket
joint, similar to our hip joint. The top of the arm bone (head of the
humerus) forms the "ball" part of the shoulder joint and the front part of the shoulder blade
(glenoid fossa) forms the "socket" part of the joint.
To allow for the large range
of mobility that the shoulder needs to move the arm in multiple
directions, what ends up is that the socket part of the shoulder joint becomes/is very shallow.
To visualize, you can imagine by
- making a fist on your left hand
- use your right hand and place it over the first
You'd see that the joint is fairly shallow and can be easily dislocated/damaged.
Around the rim of the socket is
a special band of cartilage known as the glenoid labrum. This labrum is made
of fibrocartilaginous material and what it does is that specificly deepens the shoulder socket to improve
the connection of the joint and improving stability without compromising or restricting
A Bankart lesion happens typically when there is damage to the lower portion of the
glenoid labrum, causing it to break and tear away from the bony socket.
Usually this happens when the shoulder dislocates forward, meaning the
head of the humerus is forced forwards and is pushed/popped out anteriorly of the glenoid
As it is forced forwards, it will/may damage the labrum, causing it
A vast majority of shoulder dislocations are anterior dislocations (over 95%) and are usually caused by:
A fall onto an outstretched arm, particularly if the arm is
(stretched or extended out to the side)
- externally rotated (turned outwards away from the
- extended (behind)
This is the most common cause of anterior
shoulder dislocations in older patients. Road traffic accidents (RTAs)
are another cause of traumatic shoulder dislocations.
2) Sports And Sporting Injuries
Contact injuries such as football, soccer, water polo or rugby tackles, particularly when
the arm is above the head and the elbow is pushed backwards.
movements above the head such as
can also cause this injury.
This is the most common cause of a glenoid labrum tear in
younger and more active or sporty patients.
Associated and related shoulder Injuries
With forward anterior shoulder dislocations, on top of suffering from a labrum
tear, in some cases, patients may also experience damage to one of the shoulder
- Damage to the glenoid (the socket part) is known as a Bony
Bankart. Bony Bankarts happen when there is a fracture (break) in the antero-inferior
(lower front) part of the glenoid cavity, including the glenoid labrum tear.
lesions may also be associated with fractures of the head of humerus
(the ball), such as a Hill-Sachs lesion, where there is a compression
fracture on the posterolateral (outer back) part of the humeral head.
joint capsule, a special sac that sounds the glenohumeral joint, may
also be damaged, as may be the surrounding ligaments, most commonly the
inferior glenohumeral ligament.
These all increase the risk of further shoulder instability.
Symptoms Of A Glenoid Labrum Tear
Common symptoms of a Bankart lesion include:
1) Recurrent Dislocations
episodes of shoulder dislocation are fairly common with a Bankart lesion,
particularly in younger patients. It can affect up to 80% of people under
the age of 30.
This frequency reduces with age to around 30% over time.
2) A Feeling of Looseness And/Or Instability
Patients report their shoulder may feel weak and as if it is going to dislocate again, with
actions such as throwing or lifting and moving.
A common complaint is “my shoulder feels loose and can pop out any time or especially certain angle”
Our shoulder patients with a glenoid labrum tear often complain of an aching pain which tends to be diffuse (generalized pain over a location) rather than in one spot
4) Catching/Locking Sensations
Patients may experience unusual sensations when moving the arm with a labrum tear, such as tingling pain or burning sensations etc
bankart Treatment Options
There are two treatment options for Bankart lesions, surgical and
non-surgical. The right treatment will depend on factors such as severity, age,
activity levels and levels of instability.
1) Surgical Treatment
Surgery tends to be the treatment of choice for younger patients with a
Bankart lesion, especially with patients who play sports, as there is a high
risk of the shoulder dislocating again.
This is because the glenoid
labrum tear often fails to heal properly, the reason is:
- labrum has poor blood supply, tends to heal slowly
- highly mobile area, so tends to reinjure
So when the glenoid labrum doesn’t provide the extra
depth to the socket that is needed, it reduces the stability and
increases the risk of further (recurrent) shoulder dislocation.
A Bankart lesion
repair is usually carried out arthroscopically (hey hole surgery) under
general anaesthetic. The labral tear surgery aims to repair and tighten
overstretched and damaged
- joint capsule and
Suture anchors are placed in the bone and the torn glenoid labrum is
reattached to the glenoid fossa. Typically patients can go home same-day or one day after shoulder surgery like this.
You will need to wear a protective sling, even when you sleep to protect
the shoulder for the first few weeks and allow it to heal in the correct
Shoulder physical therapy with our senior physiotherapists will be started almost immediately to
- regain strength
- stability and
You will be given a shoulder exercise and rehab
program to follow, which gradually progresses to more challenging exercises over
It usually takes around 4-6 months to recover completely and be
able to return to contact sports.
Fortunately, Bankart shoulder repair surgery
has an approximately 85-90% success rate, with most of our shoulder pain patients returning to
their pre-injury activity levels.
Outcome tends to be slightly better
when surgery is carried out soon after the initial labrum tear, rather
than further down the line.
2) Non-Surgical Treatment
For older patients, or those who are less active, conservative non-surgical treatment is recommended for a Bankart lesion.
painful shoulder and arm is immobilized in a sling for a few weeks, usually with the arm
resting across the front of the body in internal rotation (turned
inwards) and a small pillow under the armpit to hold the arm slightly
away from the body (slight abduction).
Patients are then referred to our senior physiotherapists for intensive shoulder physical therapy
to regain the
- stability and
of the affected shoulder.
of the problems with this treatment method is that in this rest
position, the glenoid labrum tends to heal in slightly the wrong place,
so the socket depth is reduced, making the shoulder more prone to
Except for young athletes, the advice is
often to try non-surgical therapy first. If the shoulder does
re-dislocate, then corrective shoulder surgery would be advised.
Physiotherapy interventions may include:
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