Understanding More About Bankart Lesion Repair

Our shoulder is best described as a ball and socket joint that allows flexible movement in various directions. However, there is a direct trade off between flexibility and stability. Due to the extreme flexibility, it is unstable and is very prone to injuries and dislocation. When the labrum is detached from the glenoid, it adds to the instability. It is very easy for the shoulder ball to pop out of the socket and when this happens, it will tear the inferior glenohumeral ligament, leading to an injury called Bankart Lesion. To recover fully, either an arthroscopic or an open surgery called the Bankart Lesion Repair will need to be carried out.

Most surgeons prefer to carry out an arthroscopic surgery due to the higher success rates, lower chances of infection and shorter recovery time. Arthroscopy is a minimally invasive surgery that involves making small incisions to the surgical site to allow the placement of small cameras and surgical tools. Due to its minimally invasive nature, the wound is very much smaller and that leads to a lower risk of infection and faster recovery process. Prior to the surgery, the patient will need to go on a food and drink fast after midnight. During the surgery, the surgeon will reattach back the labrum to the bone along the glenohumeral. The entire shoulder structure will not be modified and there is not a need to detach the subscapularis muscle. You will wake up with a sling and you should always wear it when you are sleeping to immobilise your shoulder to prevent further aggravation of your injury. It will need to be worn religiously for around 3 months.

As general anaesthesia is administered before the surgery, you will not feel any pain immediately when you wake up. However, once the effects of the anaesthesia wears off, the immediate pain will be excruciating. To prevent this sudden onset of pain, you should consume painkillers around 30 minutes before the anaesthesia wears off. To reduce swelling, you should apply ice pack to the surgical site, bearing in mind to always keep the wound nice and dry. You will be unable to use your affected hand for a few weeks. To prevent muscular atrophy, you will need to start performing physical therapy exercises under the guidance of a physical therapist. Physiotherapy will help to reduce scarring and regain the range of motion of your shoulder. It will also help to build up and strengthen your muscles to better support your weakened shoulder joint.

To enable you to continue leading a high quality lifestyle, a Bankart Lesion Repair procedure will need to be carried out to surgically reattach your labrum. This will help to prevent future reoccurrence of  your shoulder slipping out of the socket. Although the initial period after surgery will be extremely restrictive, you should persevere on and aim for a speedy recovery.

3 Types of Anterior Shoulder Instability

Shoulder instability is a condition when the ball of the shoulder is dislocated from the socket, causing problems for people. The shoulder anatomy can be explained by using a ball and socket model. The ball is able to move about in the socket, providing nearly full range of motion for the shoulder. However, this model can cause instability when the ball slips out of the socket when injured. Anterior instability is caused by the ball slipping out from the front of the socket. Anterior instability is usually caused by trauma, with a sudden impact on the shoulder either directly or indirectly.

One of the most important structures that stabilize our shoulder is the inferior glenohumeral ligament, commonly known as IGHL. The IGHL limits gross anterior-inferior subluxations and prevents any sudden movement. During an anterior shoulder injury, the sudden huge impact normally exceeds the amount of force the ligaments can withstand, thus causing tears and stretching. This will in turn lead to instability of the shoulder.

When there is the presence of Bankart lesions repair, it implies that there is a failure of the IGHL at the gelnoid insertion. The most common lesion in anterior shoulder instability is the Bankart lesion. The tear is big enough to involve the labrum, the middle labrum as well as the superoanterior labrum. Without the labrum, the ball will get dislocated from the shoulder socket and causes subluxation. As the ball pops out of the socket, the labrum is often torn in the process. Patients suffering from a Bankart lesion will experience their scapular periosteum rupturing as theirlabroligamentous ligaments are forcefully detached from the glenoid.

3 types of instability are devised for medical practitioner to plan for bankart surgery:

  1. Type 1 – Presence of a partial Bankart lesion with a small detachment of the capsulolabral complex but no indication of the capsule stripping from the glenoid labrum
  2. Type 2 – Moderate detaching of the labrum and the capsule from the glenoid, with preservation of the labral shape.
  3. Type 3 – Severe detaching of the capsulolabral complex, with attenuation of the glenoid labrum

Our shoulders play an important role in our day to day activities. It is of utmost importance to protect it. Building strong shoulder muscles is the best defence against dislocations and instability. A delay in diagnosis may lead to more serious long term problems such as arthritis. Patients should seek immediate medical assistance prevent it from getting worse.

Trimming of Torn Labrum