Bankart Lesion: Causes, Symptoms & Treatment
A Bankart lesion is a shoulder injury in which the anterior labrum detaches from the glenoid. It commonly results from shoulder dislocation and often leads to chronic joint instability.
Things worth knowing about "Bankart lesion"
A Bankart lesion is a shoulder injury in which the anterior labrum detaches from the glenoid. It commonly results from shoulder dislocation and often leads to chronic joint instability.
What is a Bankart Lesion?
A Bankart lesion is a specific injury of the shoulder joint in which the glenoid labrum – a ring of fibrocartilage that deepens the shoulder socket and helps stabilize the joint – tears away from its anterior inferior attachment. This injury is frequently associated with damage to the anterior capsulolabral complex and is one of the most common causes of chronic shoulder instability. The condition was first described by British surgeon Arthur Sidney Blundell Bankart in 1923.
Causes
A Bankart lesion most commonly results from a traumatic anterior shoulder dislocation, in which the head of the humerus is forced out of the glenoid socket toward the front. Common mechanisms of injury include:
- Falls onto an outstretched arm
- Direct blows or impacts to the shoulder
- Contact or overhead sports such as handball, volleyball, rugby, or martial arts
- Road traffic accidents
Young, physically active individuals under the age of 30 are most frequently affected. After a first-time dislocation, the risk of recurrent instability is significantly elevated due to damage to the stabilizing structures of the joint.
Symptoms
Common symptoms of a Bankart lesion include:
- Shoulder pain, particularly during specific movements such as external rotation or arm elevation
- Shoulder instability: a feeling that the shoulder may slip out of place
- Restricted range of motion
- Recurrent dislocations
- Muscle weakness or wasting due to guarding in chronic cases
Diagnosis
Diagnosis is based on a combination of clinical examination and imaging studies:
- Clinical examination: Specific tests such as the apprehension test and the relocation test are used to assess shoulder stability.
- X-ray: Used to rule out bony injuries or fractures.
- MRI (Magnetic Resonance Imaging): The gold standard for evaluating soft tissue structures, particularly the labrum and joint capsule. MR arthrography (with contrast injection into the joint) significantly improves diagnostic accuracy.
- Arthroscopy: A minimally invasive procedure that allows direct visualization of the joint and can serve both diagnostic and therapeutic purposes.
Treatment
Conservative Treatment
In cases of first-time dislocation without significant instability, conservative management may be attempted initially. This includes:
- Immobilization of the shoulder in a sling for approximately 3 to 6 weeks
- Pain management with anti-inflammatory medications (NSAIDs)
- Physiotherapy focused on strengthening the shoulder-stabilizing muscles, especially the rotator cuff
Surgical Treatment
For patients with recurrent dislocations, persistent instability, or high athletic demands, surgical intervention is typically recommended. The most common procedures are:
- Arthroscopic Bankart repair: The detached labrum is reattached to the glenoid rim using suture anchors. This is the standard procedure and yields excellent long-term outcomes.
- Latarjet procedure: In cases with significant bone loss at the glenoid, a bone block from the coracoid process is transferred to the anterior glenoid to restore stability.
Rehabilitation
Following surgery, an intensive rehabilitation program lasting approximately 4 to 6 months is required. The goal is full restoration of strength, range of motion, and joint stability. Return to competitive sport is generally possible after 6 to 9 months.
References
- Bankart ASB. Recurrent or habitual dislocation of the shoulder-joint. British Medical Journal. 1923;2(3285):1132–1133.
- Longo UG, Rizzello G, Loppini M et al. Multidirectional instability of the shoulder: a systematic review. Arthroscopy. 2015;31(12):2431–2443.
- Hasebroock AW, Brinkman J, Foster L, Bowens JP. Management of primary anterior shoulder dislocations: a narrative review. Sports Medicine Open. 2019;5(1):31.
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