Bankart repair is a surgical procedure performed to address recurrent shoulder dislocations. The shoulder is a ball-and-socket joint, where the humeral head (ball) fits into the glenoid cavity (socket). Recurrent dislocations often result from a Bankart lesion, where the labrum (a soft cartilage rim around the socket) tears and causes instability. This procedure is designed to reattach the labrum and tighten the shoulder ligaments, restoring stability.
Symptoms of a Bankart Lesion and Shoulder Instability
- Frequent shoulder dislocations: Recurrent episodes of the shoulder popping out of its socket, often from minor movements.
- Pain: Pain during or after dislocation and in activities that stress the shoulder.
- Feeling of instability: The sensation that the shoulder is loose or might dislocate with certain movements.
- Weakness: Difficulty in lifting or holding objects due to instability.
- Limited range of motion: Difficulty raising the arm or performing overhead movements.
Causes of Recurrent Shoulder Dislocation
Several factors contribute to recurrent shoulder dislocations and Bankart lesions:
- Trauma: A forceful injury, such as falling on an outstretched arm, can tear the labrum and destabilize the joint.
- Repetitive stress: Athletes involved in sports like swimming, tennis, or baseball that require overhead arm movements are more prone to labral tears.
- Congenital factors: Some individuals have naturally loose joints (joint hypermobility), which predisposes them to shoulder instability.
- Previous dislocations: Once the shoulder dislocates, the risk of recurrent dislocations increases, particularly if the initial injury wasn’t treated effectively.
Types of Bankart Lesions
- Soft Bankart Lesion: Involves a tear of the labrum without damage to the bone.
- Bony Bankart Lesion: Includes damage to the bone along with the labrum tear, typically requiring more extensive repair.
Treatment Options for Recurrent Shoulder Dislocation
Treatment depends on the severity of the instability, activity level, and age of the patient.
1. Non-Surgical Treatment
In cases of mild instability or first-time dislocation, non-surgical treatments might be considered.
- Rest and activity modification: Avoiding activities that trigger shoulder instability.
- Physical therapy: Strengthening the muscles around the shoulder, particularly the rotator cuff and scapular stabilizers, to improve joint stability.
- Bracing: Using a shoulder brace to prevent further dislocations.
- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation.
2. Surgical Treatment (Bankart Repair)
Surgery is often recommended when conservative treatments fail or if recurrent dislocations severely affect the patient’s daily life or activities.
- Arthroscopic Bankart Repair: This minimally invasive procedure is performed using small incisions and a camera (arthroscope) to repair the torn labrum. Suture anchors are placed to reattach the labrum to the glenoid, and the ligaments are tightened to stabilize the shoulder.
- Open Bankart Repair: In cases of significant damage, an open surgical approach may be needed to repair both the labrum and any bone damage.
Post-Surgery Physiotherapy
Rehabilitation after Bankart repair is crucial to restoring shoulder function and preventing future dislocations. It progresses in phases to allow healing and regain strength and range of motion.
1. Phase 1 (0–6 weeks post-op)
- Goals: Protect the repaired labrum, minimize pain, and begin gentle motion exercises.
- Treatment:
- Wearing a sling to immobilize the shoulder and protect the repair.
- Gentle passive range-of-motion (ROM) exercises guided by a therapist to prevent stiffness while protecting the repaired tissue.
- Use of ice to manage pain and swelling.
2. Phase 2 (6–12 weeks post-op)
- Goals: Restore ROM while gradually progressing to light strengthening.
- Exercises:
- Gradual progression of passive ROM exercises to restore shoulder flexibility.
- Active-assisted ROM exercises (where the opposite arm or therapist assists) to maintain mobility without stressing the shoulder.
- Gentle shoulder stretching exercises.
3. Phase 3 (3–6 months post-op)
- Goals: Regain full ROM and begin strengthening the shoulder muscles.
- Exercises:
- Active ROM exercises (without assistance) to improve shoulder mobility.
- Rotator cuff and scapular stabilization exercises using light resistance bands or small weights.
- Proprioception and balance exercises to restore joint control.
4. Phase 4 (6–9 months post-op)
- Goals: Full return to daily activities, sports, and high-intensity movements.
- Exercises:
- Advanced shoulder strengthening with heavier resistance to build muscle strength and endurance.
- Sport-specific and functional movement training for athletes, including agility drills, plyometrics, and throwing or overhead movements.
Recovery Timeline
- Return to daily activities: 3–6 months post-op.
- Return to sports: 6–9 months depending on the type of sport and intensity level.
Non-Surgical Alternatives
For individuals who are not candidates for surgery or have mild instability, non-surgical options can be explored.
- Physical therapy: Targeting strengthening of the rotator cuff, deltoid, and scapular muscles to compensate for the damaged labrum.
- Activity modification: Reducing or avoiding high-risk activities that stress the shoulder.
- Bracing: Shoulder braces can provide extra support and limit motion that might cause dislocation.
Prevention of Recurrent Dislocations
- Strengthening exercises: Regular strengthening of the shoulder’s stabilizing muscles (rotator cuff, scapular stabilizers) is essential to prevent future dislocations.
- Proper technique: Athletes should focus on proper form and technique during sports activities, particularly in overhead movements.
- Avoid high-risk activities: Limiting participation in contact sports or high-impact activities that may trigger dislocations.
Conclusion
Bankart repair is an effective procedure for treating recurrent shoulder dislocations and restoring stability to the shoulder joint. A structured physiotherapy program is critical to ensuring successful recovery and minimizing the risk of future dislocations. With proper rehabilitation and strengthening, most patients regain full shoulder function and return to their previous level of activity.