I have treated several Bankart lesions as an orthopedic physical therapist. Most have been young men that have suffered either a work or sports injury and most have been post-surgical. However, not all Bankart lesions require surgery. Read on to learn more about Bankart lesions and how to treat them. Let’s start with anatomy!
The shoulder joint
The main shoulder joint is called the glenohumeral joint. It is a large and complex joint that is made when the humerus (upper arm bone) and the scapula (shoulder blade) come together. It is a ball and socket joint. However the ball is much bigger than the socket. Think of a golf ball on a tee. The golf ball is the head of the upper arm bone and the tee is the outside part of the shoulder blade. This allows the shoulder to have the most movement of any joint in the body. However, it also has the least stability and this is what tends to get the shoulder joint in trouble.
The glenoid labrum
The area of the scapula that makes up the socket part of the shoulder joint is called the glenoid. A labrum attaches around the rim of the glenoid. It is called the glenoid labrum and is made up of fibrocartilage. It is very important in stabilizing the joint. It has a several functions, including:
- Deepening and increasing the surface area of the glenoid.
- Limiting forward and backward movement of the humeral head (ball) on the glenoid (socket).
- Resisting shoulder dislocations and subluxations (partial dislocations).
What is a Bankart lesion?
A Bankart lesion are injuries to the front lower area of the glenoid labrum. They typically occur after a shoulder dislocation. A dislocation of the shoulder occurs when the ball (the humerus) moves completely off the socket (the glenoid). Most shoulders dislocate towards the front of the body. The humerus puts excessive loading and stretching on the labrum during the dislocation. This will cause the labrum to tear and/or pull away from the glenoid. There are two types of Bankart lesions.
- Soft Bankart lesion
- This injury only involves the labrum and potentially other soft tissues.
- Most common
- Bony Bankart lesion
- This type of type of injury involves the labrum but, also, includes a fracture or break of the the glenoid.
- Could lead to bone loss of the glenoid which is the socket of the shoulder joint.
- Causes chronic shoulder instability.
What are the symptoms of a Bankart lesion?
There are several symptoms associated with a Bankart lesion. These include:
- Pain in shoulder after first or repeated dislocations
- Generalized shoulder pain
- Shoulder instability – feeling that the shoulder could dislocate again
- Catching, locking, or popping could be present
Who gets Bankart lesions?
Since Bankart lesions are typically a result of a shoulder dislocation, we need to look more at shoulder dislocations to determine which population is most at risk. Most shoulder dislocations are traumatic – meaning that they are the result of a single incident. They are more common in young men who participate in contact sports. Men are three times more likely to suffer a dislocation than a woman. However, a shoulder dislocation could also occur from other traumas, such as a fall or motor vehicle accident.
Could you get a Bankart lesion without having a shoulder dislocation?
A Bankart lesion can also occur with repetitive shoulder subluxations. This is when the ball (the humerus) slips off of the socket (the glenoid) but the bones are still in contact. This is a partial dislocation. This typically occurs with a shoulder joint that is hypermobile. The hypermobility could be genetic or it could be from repetitive activities or sports such as:
- Volleyball
- Tennis
- Handball
- Overhead activities
Will I need surgery?
The answer is maybe. It depends on the extent of the injury, the age, and the activity level of the person. There are some general guidelines to help determine if surgery is needed.
- Surgical candidate
- Traumatic dislocation in athlete 25 years old or younger
- High level athlete
- Reoccurring dislocations/subluxations
- 20-25% bone loss of glenoid
- Non-surgical candidate
- No signs of shoulder instability
- No damage to the bones of the joint
- No significant shoulder use for sports or other activities.
Who should I see?
- Orthopedist – An orthopedist is the first medical professional that you would need to see. Imaging would be required to confirm the extent of the injury, especially, if other structures are involved. The orthopedist would discuss options including surgery if needed.
- Physical therapist – A physical therapist is going to be an integral part of the healing process. Whether or not the person needs surgery or has additional injuries, they will need physical therapy. Physical therapists can aid in decreasing pain and swelling, increasing strength and stability, and returning to sport, work, and home life safely. It is important to have a physical therapist assist in determining when the person is appropriate to return to sport or work and to provide direction in how to prevent the injury from reoccurring.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage from occurring is one of the best ways to treat a shoulder dislocation and possible Bankart lesion. Most likely, the shoulder will be put in a sling and immobilized for 3-6 weeks. This gives the shoulder time to rest and heal. If you are not able to participate in your sport or activity, then you can supplement with non-irritating activities such as biking, walking, or running while your shoulder is healing.
- Ice – Ice can help decrease pain and swelling in the tendon. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Shoulder isometrics – These are the initial exercises for the shoulder. They can be performed during the period that the shoulder is in the sling. These exercises contract the muscle of the shoulder without moving the joint. See the video below to learn how to perform shoulder isometrics.
- Shoulder range of motion exercises – The shoulder might be stiff after getting out of the sling. It is important to restore full motion to the shoulder. See the video below for range of motion exercises. Having a pulley is very helpful in performing these exercises.
- Strengthen the rotator cuff and scapular stabilizers – After restoring motion to the shoulder, it is time to strengthen the rotator cuff and scapular stabilizers. The role of the rotator cuff is to keep the ball in the socket of the shoulder joint. These muscles are very important and need to be strengthened in the case of shoulder instability. The scapular stabilizers are the muscles around the shoulder blade which help stabilize the shoulder joint while your arm is performing different activities. These muscles need to be strong to perform repetitive or stronger tasks without injury. The videos below review some strengthening exercises for the rotator cuff and the scapular stabilizers. Using loop resistance bands and resistance bands can increase strength and difficulty.
- Posture – Having forward rounded shoulders causes muscular imbalances in the shoulder. It stretches out the rotator cuff and scapular stabilizing muscles which are important for shoulder stabilization. It also shortens and causes tightness in the pectoralis major, pectoralis minor, and the biceps. If these muscles are tight, they will roll the shoulder forward. Below is a video showing how to stretch the pecs and biceps and also how to use a wall to check your posture.
In review
- The main shoulder joint is called the glenohumeral joint.
- It is a large and complex joint that is made when the humerus (upper arm bone) and the scapula (shoulder blade) come together.
- The shoulder has the most movement of any joint in the body.
- However, it also has the least stability and this is what tends to get the shoulder joint in trouble.
- The area of the scapula that makes up the socket part of the shoulder joint is called the glenoid.
- A labrum attaches around the rim of the glenoid.
- It is very important in stabilizing the joint.
- A Bankart lesion are injuries to the front lower area of the glenoid labrum.
- They typically occur after a shoulder dislocation.
- Can also occur after repeated subluxations.
- They are more common in young men who participate in contact sports.
- An orthopedist would be needed to determine the extent of the shoulder injury and determine if further medical intervention including surgery would be needed.
- Physical therapy will play an integral role in returning to normal life and sport whether surgery is needed or not.
- There are things that you can do.
- Relative rest
- Ice
- Shoulder isometrics
- Shoulder range of motion
- Strengthening
- Posture
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.physio-pedia.com/Bankart_lesion
https://www.orthobullets.com/shoulder-and-elbow/3050/traumatic-anterior-shoulder-instability-tubs