What is a Bankart lesion, (glenoid labrum tear)?

A Bankart lesion is a tear in the connective tissue that assists in holding your shoulder in its socket. It occurs when your shoulder is forced into the connective tissue from the front of its socket.

Your shoulder is the cup of your shoulder blade or scapula in which the rounded top of your upper arm bone or humerus fits. A ring of cartilage lines and extends the socket to support the shoulder joint.

Your glenoid labrum is what they call that ring of cartilage. If your shoulder bone is driven out and then pushed into the glenoid labrum, it can tear the labrum or even separate it from the bone entirely. That would be a Bankart lesion.

An injured shoulder can be quickly popped back into place by a healthcare provider, but this does not mend a Bankart lesion. This more chronic condition makes your shoulder joint unstable, increasing its liability to dislocate again.

How prevalent are Bankart lesions?

Shoulder dislocations are the most common shoulder injuries. These are found in approximately 1% of the population. Almost 90% of shoulder dislocations involve the front of the socket as an anterior type.

The glenoid labrum tear is the most common consequence of the anterior shoulder dislocation — and between 87% and 100% of them do. So, if you have dislocated your shoulder, you're very likely to have a Bankart lesion.

What is a bony Bankart lesion?

If your glenoid labrum and shoulder socket bone, called your glenoid, are injured, your healthcare provider may say you have a bony Bankart lesion. That means the tissue is torn, and the bone is fractured.

Bony (or skeletal) Bankart lesions are less common than soft (or fibrous) Bankart lesions. These only affect the glenoid labrum. About 73% of anterior shoulder dislocations have a bony Bankart lesion.

What causes a Bankart lesion?

A Bankart lesion or glenoid labrum tear occurs when your shoulder bone dislocates and tears the supportive tissues around it. A dislocated shoulder is a traumatic injury caused by some significant force.

Common causes of shoulder dislocations include:

• Car crashes.
• Sports injuries.
• Falls.

What are the symptoms of a Bankart lesion?

Bankart lesion symptoms can include:

• The shoulder: Generalised shoulder pain, or more commonly concentrated in the front lower part of the shoulder socket. Be aware of whether this is constant and not improving with time and rest.
• Restricted movement: Problems with lifting/throwing or reaching, getting dressed, or wearing a seatbelt.
• Mechanical symptoms: You may feel a grinding or sometimes a popping sensation that you feel when your shoulder joint moves in a certain way and catches or locks with soreness.
• Shoulder instability: Other times, your shoulder joint may feel loose or the bone moves too much when you are trying to rotate your shoulder. It may even dislocate again.

How is a Bankart lesion diagnosed?

A healthcare provider will first of all assess you on your shoulder injury-by how and when it could have occurred. If the trauma has happened to you before, you would notify them, and then they would continue by examining your shoulder joint physically for signs of instability.

They shall examine the damage through imaging tests. Many of them shall require X-rays, and the MRI has to be done. They may need to demonstrate how much damage is done to your glenoid labrum and whether there is some other injury to it as well.

Are Bankart lesions surgery?

Not all glenoid labrum tears need to be treated with surgery. However, some of them do. Bankart lesions may sometimes spontaneously resolve. However, some may not heal quite so well without repair. Sometimes, your doctor will determine that you need surgery if:

• The glenoid labrum has been torn from the bone, and you would need surgery to attach the labrum again.
• You have a bony Bankart lesion, meaning you lost some bone.
• You're suffering from recurrent shoulder instability because of an earlier injury.
• Your daily activity or work mainly depends on your shoulder joint.

What happens if a Bankart lesion is not treated?

Bankart lesions heal, even without treatment; however, they don't heal properly, and sometimes, your shoulder joint remains unstable. This has a higher propensity to dislocate and tear your labrum again.

Only your doctor can tell you if the injury likely heals independently. Even if you do not have surgery, you need to look after your shoulder joint well for it to heal correctly.

What is surgical repair for a Bankart lesion?

Surgery for a Bankart lesion is merely the debridement of dead or damaged tissue and the repair of the tear in healthy tissue. Your surgeon may then replace your glenoid labrum with the glenoid bone.

Surgeons attach tiny anchors to the socket bone and then stitch the glenoid labrum tissue to these anchors. They gently pull the stitches tight to restabilize the joint. Sometimes, this is called a Bankart repair.

Surgeons might be able to perform a Bankart repair through shoulder arthroscopy. This operation involves minimal incisions, through which the surgeon passes a small tube with a camera at one end, referred to as an arthroscope, to visualize the shoulder so that the surgeon can complete the repair work through that tube.

Minimally invasive approaches like shoulder arthroscopy decrease the recovery period and make recovery easier. However, open shoulder surgery might sometimes be necessary for severe injuries so that proper repair of the tear can be done.

How is a Bankart lesion treated?

Rest and rehabilitation will be needed to heal your shoulder. A period of being kept relatively immobilized in a sling after the injury, followed by a course of physiotherapy, will be unavoidable.

A physiotherapist will devise an exercise program designed to gradually increase muscle strength and range of movement. This process also helps restore joint stability and reduce the chance of recurrence.

What's the outlook with a Bankart lesion?

You may or may not need surgery for a Bankart lesion. In both cases, the outlook afterward is good. Most people recover superbly from a Bankart lesion, although you cannot expect your shoulder to return fully to normal within six months after injury.

The most significant threat after repair is residual instability of your shoulder, which causes this dislocation and once again tears your labrum. This is highly unlikely after surgery if you go through with physical therapy.

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