A Bankart lesion, aka glenoid labrum tear, usually occurs when the shoulder dislocates forwards, damaging the lower part of the special cartilage that lines the shoulder socket. It most commonly affects young athletes. Damage to the labrum makes the shoulder more prone to instability and there is a high risk of further shoulder dislocation without appropriate treatment.
Bankart lesions are named after English Orthopedic Surgeon Arthur Sydney Blundell Bankart, 1879-1951, who first described the injury and the surgical repair process.
Here we will look at the common causes, associated injuries, symptoms and treatment options, both surgical and non surgical, for a Bankart lesion labrum tear.
To fully understand Bankart lesions, we need to first understand the structure of the shoulder. The shoulder is a ball and socket joint, similar to the hip. The top of the arm bone (head of the humerus) forms the ball and the front part of the shoulder blade (glenoid fossa) forms the socket.
To allow for the large range of mobility that the shoulder needs to move the arm in multiple directions, the socket is very shallow. Imagine a golf ball sitting on top of a golf tee, not very stable. So, around the rim of the socket is a special band of cartilage known as the glenoid labrum. This is made of fibrocartilaginous material and works to deepen the socket to improve the connection of the joint and improving stability without restricting mobility.
A Bankart lesion is when there is damage to the lower portion of the glenoid labrum, causing it to tear away from the bony socket. This tends to happen when the shoulder dislocates anteriorly, meaning the head of the humerus is forced forwards and pops out of the glenoid socket. As it is forced forwards, it can damage the labrum, causing it to tear. A vast majority of shoulder dislocations are anterior dislocations (over 95%) and are usually caused by:
A fall onto an outstretched arm, particularly if the arm is abducted (out to the side), externally rotated (turned outwards away from the body) and extended (behind). This is the most common cause of anterior shoulder dislocations in older patients. Road traffic accidents (RTA’s) are another traumatic cause of dislocations.
Contact injuries such as football or rugby tackles, particularly when the arm is above the head and the elbow is pushed backwards. Repetitive movements above the head e.g. throwing or overhead racquet sports such as tennis. This is the most common cause of a glenoid labrum tear in younger patients.
With anterior shoulder dislocations, as well as suffering from a labrum tear, in some cases, there may also be damage to one of the shoulder bones. Damage to the glenoid (the socket part) is known as a Bony Bankart. This is when there is a fracture (break) in the anteroinferior (lower front) part of the glenoid cavity, as well as a labrum tear.
Bankart lesions may also be associated with fractures of the head of humerus (the ball), such as a Hill-Sachs lesion, where there is a compression fracture on the posterolateral (outer back) part of the humeral head.
The joint capsule, a special sac that sounds the glenohumeral joint, may also be damaged, as may be the surrounding ligaments, most commonly the inferior glenohumeral ligament.
These all increase the risk of further shoulder instability.
Common symptoms of a Bankart lesion include:
1) A Feeling of Instability: the shoulder may feel weak and as if it is going to dislocate again, with actions such as throwing. A common complaint is “I just don’t trust my shoulder anymore”
2) Recurrent Dislocations: repeated episodes of shoulder dislocation are common, particularly in younger patients, affecting up to 80% of people under the age of 30. This frequency reduces with age to around 30%
3) Pain: an aching pain which tends to be diffuse rather than in one spot
4) Catching/Locking Sensations: when moving the arm
There are two treatment options for Bankart lesions, surgical and non-surgical. The right treatment will depend on factors such as age, activity levels and levels of instability.
Surgery tends to be the treatment of choice for younger patients with a
Bankart lesion, especially those who play sports, as there is a high
risk of the shoulder dislocating again. This is because the glenoid
labrum tear often fails to heal properly, so doesn’t provide the extra
depth to the socket that is needed, reducing the stability and
increasing the risk of further dislocation.
A Bankart lesion repair is usually carried out arthroscopically (hey hole surgery) under general anaesthetic. The labral tear surgery aims to repair and tighten overstretched and damaged ligaments, joint capsule and cartilage. Suture anchors are placed in the bone and the torn glenoid labrum is reattached to the glenoid fossa. You can usually go home the same day, or the following day.
A sling will need to be worn (including when you sleep) to protect the shoulder for the first few weeks and allow it to heal in the correct position. Physical therapy will be started almost immediately to regain strength, stability and movement. You will be given a rehab programme to follow, progressing to more challenging exercises over time. It usually takes around 4-6 months to recover completely and be able to return to contact sports.
Bankart shoulder repair surgery has an approximately 85-90% success rate, with most people returning to their pre-injury activity levels. Outcome tends to be slightly better when surgery is carried out soon after the initial labrum tear, rather than further down the line.
For older patients, or those who are less active, non-surgical treatment is recommended for a Bankart lesion. The arm is immobilized in a sling for a few weeks, usually with the arm resting across the front of the body in internal rotation (turned inwards) and a small pillow under the armpit to hold the arm slightly away from the body. This is then followed by intensive physical therapy to regain the strength, stability and mobility of the shoulder.
One of the problems with this treatment method is that in this rest position, the glenoid labrum tends to heal in slightly the wrong place, so the socket depth is reduced, making the shoulder more prone to recurrent dislocations.
Except for young athletes, the advice is often to try non-surgical therapy first. If the shoulder does re-dislocate, then surgery would be advised.
A Bankart lesion is just one possible cause of shoulder pain and instability. The upper part of the glenoid labrum may be damaged, known as a SLAP tear causing pain and instability with overhead movements.
You can find out more about other causes in the Common Shoulder Problems section - coming soon.
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