What is a Bankart Lesion? - Signs, Symptoms and How to Repair

The labrum is a part of the shoulder joint that provides stability to the joint. There might be a tear in the labrum due to certain reasons, such as accidents or overuse of the shoulder joint resulting in detachment of the labrum from the glenoid cavity. This tear or injury to the labrum is known as Bankart Injury or Bankart Lesions. Bankart injury may result in a feeling of the shoulder slipping out of the socket.

The shoulder joint is complex and one of the most movable joints in the human body. It is a ball and socket joint in which the head of the arm bone, the humerus, is fitted into the glenoid cavity of the scapula (shoulder bone). The glenoid cavity is shallow and deeper because of the presence of a fibrocartilagenous ring around the glenoid cavity. This fibrocartilagenous ring is known as the labrum. It provides extra stability to the shoulder joint.

Based on the location of injury in the labrum, the bankart surgery is of two types:

1. Anterior Bankart Injury: In the Anterior Bankart Injury, the head of the humerus dislocates from the glenoid cavity in the forward and sideways direction. 
2. Posterior Bankart Injury: In the Posterior Bankart Injury, the head of the humerus dislocates from the glenoid cavity in the backward direction.

Many of the signs and symptoms of a bankart injury are similar to those of other shoulder injuries. Patients with bankart injury may experience the following symptoms:

1. Persistent pain in the arm during routine activities that do not get relieved by over-the-counter medicines or ice packs. Pain increases when the patient moves their hand behind the back.
2. Feeling of shoulder slipping out of the cavity.
3. Recurrent shoulder dislocations even with less movement, such as wearing a seat belt or rolling on the bed.
4. Weakness in the arms.
5. Limited range of motion.
6. Locking, popping, catching, or grinding due to damaged tissues between the joints.

Generally, bankart injury is caused due to high-force trauma on the shoulders. It may also be due to repetitive motions of the arm. Although the injury may occur at any age, younger people are at increased risk of developing the bankart injury. Some of the possible causes of bankart injury are:

1. Contact sports injuries include shoulder shoving with force while playing hockey or badminton, falls during skating or gymnastics, and overuse of shoulder joints in sports like weight lifting or swimming.
2. Car accidents result in a sudden jerk to the body and shoulders.
3. Fall from the ladder or stairs.
4. Underlying medical conditions that result in loss of ligaments throughout the body (genetic predisposition), such as hypermobility syndrome,

Bankart Injury can develop in any age group. However, the following are the probable risk factors for bankart injury:

1. Age
2. Overhead activities (weightlifting) and repetitive arm motion (hammer swinging)
3. Athletes play volleyball, handball, tennis and contact sports such as hockey

There are measures to reduce the risk of bankart injury as it can’t be prevented fully, Some methods to prevent bankart injury:

1. Avoid overuse of the arms, and do not perform repetitive actions without a break.
2. Take precautions to avoid any falls, especially for older people.
3. Always wear protective gear during strenuous sports activities
4. Routine exercise strengthens joints and improves muscle health.

The first thing to do in bankart injury is to consult a doctor. The doctor diagnoses the bankart injury through the following methods:

1. Physical examination: The doctor performs a comprehensive examination to evaluate the cause of pain and swelling in the shoulders. The doctor may also perform various tests to determine shoulder dislocation. These tests include the Load and Shift test and Anterior Apprehension test.
2. X-ray: The labrum is a soft tissue, so the x-ray cannot detect the tear. However, the doctor may recommend an x-ray to rule out other causes, such as shoulder dislocation and any other damage to the joint.
3. CT scan: CT scan can be used to perform arthrography. It helps in detecting the injury, which is caused due to joint instability. The sensitivity of CT arthrography in detecting tears is 73%.
4. MRI: It is a non-invasive imaging technique that uses non-ionizing radiations. The doctor may advise MRI in suspected cases of labral abnormalities. It can obtain images at several planes, thus allowing the doctor to examine posterior, anterior, superior and inferior portions of the labrum. The sensitivity of MRI imaging in detecting tears is 93%.
5. MR Arthrography: MR arthrography involves the use of MRI and a dye injected directly into the joint (direct arthrography) or the blood (indirect arthrography). It is more sensitive in detecting labral tears, with a sensitivity of 95%. The doctor may also inject drugs, such as cortisone, to reduce the swelling, which helps obtain a clear image.
6. Arthroscopy: It is a minimally invasive procedure for diagnosing and treating joint disorders. In this method, the doctor makes a small incision on the shoulder. The doctor then inserts an arthroscope, which is a long tube with a camera at the end, to view the presence and extent of damage to the labrum. 
7. Electromyography: The doctor may also advise the patient for electromyography to determine if there is any damage to the nerves and the related muscles due to shoulder dislocation. Electrical signals from the neurons result in muscle contraction. During electromyography, the doctor inserts tiny needle electrodes into the muscles to record the electrical activity in that particular muscle. The electrical activity is obtained through graphs, numerical values or sound, which are then analysed by the experts. 

How to prepare for the doctor's consultation?

Below mentioned are some of the information that a patient can prepare before the appointment with the doctor.

1. Should book an appointment with the orthoapedician if they experience the symptoms of shoulder dislocation or Bankart injury.
2. Expect registration and consultation fees when they visit the doctor for the first time.
3. Should provide detailed information about the pain, discomfort, and medical history to the doctor.
4. Require to undergo diagnostic tests, such as MRI, CT scan, or arthroscopy.
5. Seek detailed information about preventing disease progression, precautions to be taken, recovery time, and treatment outcome.

Once the bankart injury is confirmed, the treatment depends on the extent of damage, pain, and discomfort experienced by the patient. 

Bankart Injury Treatment without Surgery

1. Medications: The doctor may prescribe certain medications that will help in improving the symptoms of bankart injury, such as pain and discomfort. These medications will include anti-inflammatory drugs. 
2. Rest: The doctor may advise the patient to take adequate rest. Rest may be with or without the use of the sling. The doctor will instruct the patients to avoid moving the shoulder and to play any sport that would put pressure on the shoulders. The doctor may also recommend the patient for rehabilitation exercises.
3. Physical therapy: The doctor may also recommend the patient consult a physiotherapist for physiotherapy sessions. During the session, the physiotherapist will instruct the patient to perform some exercises, depending on the condition of the shoulder.

Bankart Injury Treatment with surgery

When the non-invasive therapies for bankart injury fail to provide relief to the patient and the patient has recurrent shoulder dislocation, the doctor will advise the patient to undergo surgery. The surgery for the bankart injury may be open surgery or arthroscopy.

1. Shoulder Arthroscopy: It is a minimally invasive procedure for labrum repair. In this surgery, the surgeon makes a tiny hole at the site of surgery and inserts an arthroscope to view the ruptured labrum. Then, the surgeon, through the hole, inserts the instrument. Next, the anchor is placed in the bone near the labrum tear. The sutures pull the anchors, thereby moving the labrum back near the bone. 
2. Open Surgery:  In some cases, such as failed arthroscopic bankart injury treatment, the surgeon performs open surgery. It has been reported that in the failed arthroscopic surgery for bankart injury, the open surgery provides a positive outcome that includes a relatively fewer recurrence rate and improved functional return.

If bankart injury is not treated in time, then it can worsen the symptoms which can be troublesome. The complications of bankart injury include:

1. Instability
2. Dislocations
3. Pain
4. Weakness
5. Reduced quality of life

When to see a doctor?

The patient should consult the doctor if they experience:

1. Pain and swelling in the shoulder joint, especially after a fall or a vehicle accident.
2. A feeling of the shoulder joint slipping out from its place.
3. Persistent limited range of arm motion.
4. Clicking or grinding in the shoulder joint.

Several foods aid in a quicker recovery from a shoulder injury. These foods include:

1. Salmon, sardines, cod liver oil, egg yolks, mushrooms, and fortified meals like cereal, oatmeal, and soy milk are foods high in vitamin D and calcium for stronger bones.
2. Foods with high protein like fish, chicken, beef, tofu, soybeans, peas, almonds, seeds, and beans.
3. Foods like pulses, nuts, seeds, whole grains, fish, meat, and shellfish with zinc and magnesium are good for tissue repair and growth.
4. Food with high Vitamin C content like kiwi, berries, mango, papaya, tomatoes, and green vegetables like broccoli and red or yellow bell peppers.
5. Foods high in vitamin A, such as carrots, spinach, and broccoli.