Shoulder Dislocation and Bankart Repair
Shoulder Dislocation
A dislocation is an injury to a joint in which the ball comes out of the socket, similar to a golf ball coming off the golf tee. The shoulder is a “ball-and-socket” joint where the “ball” is the rounded top of the arm bone (humerus) and the “socket” is the cup (glenoid) of the shoulder blade. A layer of cartilage called the labrum cushions and deepens the socket. A shoulder dislocation occurs when the humerus pops out of its socket, either partially or completely. As the body’s most mobile joint, able to move in many directions, the shoulder is most vulnerable to dislocation. A shoulder dislocation may be caused by a sports injury, trauma from a motor vehicle accident, or a fall.
Symptoms of Shoulder Dislocation
Dislocation causes pain and unsteadiness in the shoulder. The shoulder may be visibly deformed or look out of normal placement. Other symptoms of a dislocated shoulder may include:
- Swelling
- Numbness
- Weakness
- Bruising
The muscles in the shoulder may spasm and cause tingling sensations in the neck and down the arm. Complications of a shoulder dislocation may also include muscle tears, tendon or ligament injuries, and blood vessel or nerve damage.
Diagnosis of Shoulder Dislocation
A shoulder dislocation is diagnosed through a physical examination and a review of symptoms. Additional diagnostic tests may include:
- X-ray
- MRI scan
- Electromyography
The electromyography test is used to determine whether there is any nerve damage as a result of the shoulder dislocation.
Treatment of Shoulder Dislocation
In most cases, the dislocated shoulder can be manipulated back into place by a doctor in a process known as closed reduction. When the shoulder bone is back in place, severe pain normally subsides. The arm and shoulder are then immobilized in a special splint or sling for several weeks as the shoulder heals. Medication may also be prescribed for pain. A shoulder that is severely dislocated or in cases where surrounding ligaments or nerves have been damaged, surgery may be necessary to tighten stretched ligaments or reattach torn ones.
After treatment for a shoulder dislocation, when pain and swelling have subsided, physical therapy is recommended to restore the range of motion of the shoulder, strengthen the muscles, and prevent future dislocations. After treatment and recovery, a previously dislocated shoulder may remain more susceptible to reinjury, potentially resulting in chronic shoulder instability and weakness.
Arthroscopic Bankart Repair
The socket of the shoulder, or glenoid, is covered with a layer of cartilage called the labrum that cushions and deepens the socket to help stabilize the joint. Traumatic injuries and repetitive overhead shoulder movements can tear the labrum, leading to pain, limited motion, instability and weakness in the joint. Symptoms of a labral injury may include shoulder pain and a popping or clicking sensation when the shoulder is moved, as well as rotator cuff weakness. One of the most common labral injuries is known as a Bankart lesion. This condition occurs when the labrum pulls off the front of the socket. This occurs most often when the shoulder dislocates. If a Bankart tear doesn’t heal properly, it can cause future dislocations, instability, weakness and pain.
Bankart lesions may be treated through conservative methods such as rest, immobilization and physical therapy, particularly in older patients. However, many cases require surgery to reattach the torn labrum to the socket of the shoulder. This procedure is often performed through arthroscopy which is especially effective in treating joint conditions such as Bankart repair.
The Arthroscopic Bankart Repair Procedure
Surgery to repair a Bankart lesion is often performed through arthroscopy. Arthroscopy is a minimally-invasive technique that uses tiny incisions to insert a probe-like camera, allowing the surgeon to fully examine the area before performing corrections. After making the incisions, the surgeon also inserts specialized instruments through the arthroscope to repair the damage to the shoulder at the exact location of the injury. Any tears in the muscle, tendon, or cartilage will be fixed and any damaged tissue is removed. After the procedure, the incisions are stitched closed.
Recovery from Arthroscopic Bankart Repair
After arthroscopic Bankart repair, patients will generally be required to keep their arm immobilized in a sling for approximately one month. However, physical therapy will begin on or about day 5 following surgery. In addition, patients will undergo physical therapy for about four months to strengthen the muscle tissue and improve the range of motion in the shoulder. Patients are often restricted from participation in contact sports for a six-month period after surgery, to allow the shoulder to fully heal.
Risks of Arthroscopic Bankart Repair
As with any surgical procedure, there are risks associated with arthroscopic Bankart repair that may include:
- Recurrent Instability
- Bleeding
- Infection
- Blood clots
- Shoulder stiffness
- Blood vessel or nerve injury
- Post traumatic arthritis.
Arthroscopic Bankart repair results in minimal pain and trauma and less scarring and damage to surrounding tissue than traditional open surgery. There is also a shorter recovery period and a shorter length of rehabilitation than with traditional open surgery. This outpatient procedure is often a successful option for many patients, allowing them to return to regular activities once again.
