Bankart’s lesion/ Recurrent shoulder dislocation
What is a Bankart’s lesion?
It is an injury sustained on the frontal and lower aspect of the shoulder joint capsule(labrum complex) when there is a traumatic dislocation of the shoulder.
It is often associated with a corresponding bony defect on the humeral head known as Hill-Sach’s lesion.
Bankart and corresponding Hill-Sachs lesion
What is the management of 1st time traumatic dislocation of shoulder?
Xrays will be done to confirm the diagnosis of shoulder dislocation, as well as to rule out any fractures. On confirmation, your doctor will guide you for a reduction of the dislocation under short sedation/anaesthesia. It’s a short (day care) procedure. You will be given a shoulder sling immobilser to use for 10-14 days, following which mobilisation exercises will be started. This first event of dislocation may predispose to further episodes of repeated dislocations in the future.
What is recurrent dislocation of shoulder?
Shoulder is the most mobile joint in your body. It helps you to lift your arm, to rotate it, and to reach up above your head. It is able to turn in multiple directions. This greater range of movement, however, can cause instability.
Shoulder instability occurs when the head of the upper arm bone is forced out of the shoulder socket. This typically happens as a result of a sudden injury, such as a fall or accident.
Once a shoulder has dislocated, it is vulnerable to repeat episodes. When the shoulder is loose and slips out of place repeatedly, it is called chronic shoulder instability.
What are the symptoms of recurrent dislocation of shoulder?
Symptomatic dislocators are the individuals in whom there is difficulty in doing daily tasks of overhead activities like combing hair, bathing, throwing,etc. They experience an apprehension about the arm bone being dislodged from the socket while doing so. Playing any kind of recreational sport which requires throwing/swinging/bowling action is painful and the shoulder doesn’t feel stable enough.
What is the management?
Surgery is offered to patients with repeated dislocations to repair torn or stretched ligaments so the liagments are better able to hold the shoulder joint in place. The procedure is performed via arthroscopy, so it is a minimally invasive(key-hole) surgery. At times, due to the severity of bone loss in chronic dislocations, a mini-open surgery. The two most common surgical procedures done are:
- Bankart’s repair
- Latarjet procedure
What is Bankart’s repair?
In this procedure, the torn ligaments are re-attached to the proper place in the shoulder joint, using implants called as suture anchors. Strong sutures are passed through the loose capsulo-ligamentous tissue and these are then passed through the eyelet of the anchor. These anchors are then hammered into the bone while pulling the sutures. This ensures firm and tight re-attachment of the ligaments and capsule at their point of original attachment. The procedure is done via arthroscopy.
What is a Latarjet procedure?
This procedure involves removing a piece of bone from another part of the shoulder(coracoid), and attaching it to the front of your shoulder socket(glenoid) via screws. This bone will then act as a barrier which will physically block the shoulder from slipping out of the socket, while the muscles which are transferred with the bone will give additional stability to the joint.
What is hyper-laxity?
Some people with shoulder instability have never had a dislocation. Most of these patients have loose ligaments in their shoulders. When this increased looseness is just your normal anatomy, it is called hyperlaxity.
Usually, this looseness is the result of repetitive overhead motion. Swimming, tennis, and volleyball are among the sports requiring repetitive overhead motion that can stretch out the shoulder ligaments.
Most of these individuals will not require surgery, as the extra mobility is desired for their performance. But in a few, the shoulder may be painful and loose to carry out activities of daily living. In such painful, unstable shoulders, surgery may be indicated.
In a small minority of patients, the shoulder can become unstable without a history of injury or repetitive strain. In such patients, the shoulder may feel loose or dislocate in multiple directions, meaning the ball may dislocate out the front, out the back, or out the bottom of the shoulder. This is called multidirectional instability. These patients have naturally loose ligaments throughout the body. They do not require any surgical procedure.
Signs of Generalised Hyper-laxity