A Bankart lesion is a tear of the labrum from the glenoid (socket of the shoulder) along with the attached stabilizing capsule and ligaments. A Bankart lesion may occur when the shoulder dislocates and the stabilizing structures of the shoulder are injured.
What Is a Bankart Tear?
The labrum is the soft tissue bumper that surrounds the rim of the glenoid (socket), helping to keep the head of the humerus in place. Ligaments that attach from the glenoid to the humeral head also assist in keeping the shoulder stable. The rotator cuff muscles surrounding the shoulder also contribute to shoulder stability.
When the shoulder dislocates from the glenoid, the stabilizing structures may be injured, including the humeral and glenoid bone, labrum, capsule and ligaments, and rotator cuff. In younger, active patients, a shoulder dislocation typically tears the labrum off the glenoid along with the attached stabilizing capsule and ligaments. When this occurs, it is called a Bankart lesion.
Causes and Risk Factors
A Bankart lesion may result from a shoulder dislocation injury. Causes and risk factors for posterior shoulder instability include:
- A direct blow to the shoulder
- Falling on an outstretched arm in front of the body
- Repetitive throwing motion or swimming
- A shoulder dislocation injury
- A congenital abnormality, such as a shallow or malformed joint surface
- Violent muscle contractions associated with seizures
- Contact sports such as football, wrestling, and basketball
- Sports involving repetitive overhead activity, such as baseball, volleyball, and swimming
- Sports requiring forceful lifting, hitting, or twisting
- Previous shoulder dislocations or sprains
- Shoulder fracture or repeated shoulder injury
- Poor physical conditioning, including strength and flexibility
Symptoms
Signs and symptoms may include:
- Severe shoulder pain at the time of a dislocation injury
- Loss of shoulder function and severe pain when attempting to move the shoulder
- Apprehension or a feeling that the shoulder wants to slip out of place with certain positions
- Tenderness, deformity, and swelling
- Pain with shoulder movement, especially when reaching overhead or lifting heavily
- Pain that awakens you at night
- Loss of strength
- Numbness or paralysis in the upper arm and deltoid muscle from pinching, stretching, or pressure on the blood vessels or nerves
- A crepitation (“crackling”) feeling or sound when the injured area is touched or with shoulder motion
- Decreased or absent pulse at the wrist because of blood vessel damage, in rare cases
Treatment
Shoulder dislocations should be reduced (put back in place) as soon as possible for patient comfort and to release potentially damaging traction on nerves and blood vessels. Following reduction, early range of motion and gentle strengthening should begin to restore shoulder function.
In younger, more active patients, surgery is sometimes needed to repair the labrum with its ligaments and capsule to prevent instability and pain. Surgery is sometimes recommended to repair the torn labrum and capsular ligaments to best restore shoulder stability and alleviate symptoms.
Younger patients may require arthroscopic surgery to repair the torn labrum, capsule, and ligamentous structures and, in some cases, fractures of the bone or tears in the rotator cuff. Older patients often return to previous levels of function without surgery unless they sustain a fracture or rotator cuff tear that requires surgery.
Recovery and Outcomes
Following reduction of a posterior shoulder dislocation, functional outcomes can be excellent and re-dislocation rates are lower with proper treatment. For younger, active patients who continue to experience instability or pain, arthroscopic repair of the injured stabilizing structures, mostly the torn labrum, capsule, and ligaments, can be beneficial.
Posterior shoulder dislocations may result in continued subtle instability that causes asymmetric wear of the glenoid cartilage and bone and can result in early post-traumatic arthritis. Posterior dislocations that are discovered late and have not been reduced have less desirable outcomes and often require more complex surgery to reduce and maintain a stable shoulder.
When to See Dr. Chudik
Schedule an evaluation after any shoulder dislocation, when the shoulder feels unstable in specific positions, or if prior treatment has not resolved instability symptoms. Call 630-324-0402 or request an appointment online.