Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)

What is Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)?

The glenoid labrum is a type of cartilage that forms a ring around the shoulder socket, helping to stabilize the shoulder joint. It helps to increase the surface area of the shoulder socket by 75% vertically and 57% horizontally. A Bankart lesion is an injury that occurs when the front part of this labrum detaches from the shoulder socket, often accompanied by damage to the connecting tissues below the mid-point of the socket. This can cause instability in the shoulder due to the loss of certain functions such as the labrum’s stabilizing effect, the inward pressure provided by the rotator cuff, or the role of the lower part of the shoulder ligament.

Injuries like shoulder joint subluxations or dislocations often result in damage to the glenoid labrum. In fact, nearly all (between 87 to 100%) of first-time shoulder dislocations happen along with Bankart lesions.

What Causes Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)?

Injuries to the glenoid labrum, an important part of the shoulder, most often happen due to traumatic shoulder dislocation. This mainly happens to people participating in contact or collision sports. Both first-time and recurring shoulder dislocations can cause different levels of damage to the glenoid labrum.

Examples of these damages include Bankart lesion, SLAP lesion (which stands for Superior Labral lesion Anterior to Posterior), ALPSA lesion (Anterior Labral Periosteal Sleeve Avulsion), and HAGL lesion (Humeral Avulsion of Glenohumeral Ligament). Among these, a Bankart lesion specifically happens when the shoulder dislocates forward with the arm turned outward and lifted up.

When a shoulder dislocates, the head of the humerus bone moves abnormally, leading to excessive strain and stretching of the labrum and surrounding ligament structures. This heavy strain can lead to the labrum tearing or coming away from its normal position, often resulting in injury to the surrounding tissue.

Risk Factors and Frequency for Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)

Shoulder dislocations affect 1% of people and are more often found in the front of the shoulder, accounting for 90% of cases. These dislocations usually result from physical trauma and are three times more common in men. For young athletes, if they don’t opt for surgery, the recurrence rate for such dislocations is over 90%.

• A shoulder dislocation is seen in 1% of the population, most often in the anterior (front) part of the shoulder (90%).
• They are usually caused by physical trauma and are the leading cause of shoulder injuries.
• Dislocations occur three times more frequently in men.
• For young athletes, without surgery, the dislocation is likely to recur over 90% of the time.

There are several injuries associated with an anterior shoulder dislocation, including:

• A Bankart lesion (87 to 100% of cases)
• A Hill-Sachs lesion (90% of cases)
• A bony Bankart lesion (73% of cases)
• A rotator cuff injury (13% of cases)
• A SLAP (Superior Labral lesion Anterior to Posterior) (10% of cases)
• Perthes lesion, Anterior Labral Periosteal Sleeve Avulsion (ALPSA), Gleno-Labral Articular Disruption (GLAD), and Humeral avulsion of Glenohumeral Ligament (HAGL) occur less frequently.

Signs and Symptoms of Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)

Glenoid labral lesions, which can often lead to recurring shoulder instability and general shoulder pain, are common signs in patients who have what’s known as a Bankart lesion. These patients typically have had their shoulder dislocated in the past. Some patient symptoms might also include feeling like their shoulder ‘catches’, locks, or pops.

To properly evaluate a Bankart lesion, it’s important for your doctor to ask many questions about your medical history. This can include any past shoulder dislocations, how many you’ve had, how they were treated, whether it’s impacted on your work or sports activities, and even if you have any history of epilepsy. Here is a list of key questions that usually come up:

• Your age and job
• Your level of physical activity, including contact sports
• When you first dislocated your shoulder
• How many times your shoulder has been dislocated or partially dislocated
• What caused the dislocation
• Any other injuries you sustained along with the dislocation
• Whether you were able to push your shoulder back into place yourself, or needed medical help to do so
• If you’ve ever dislocated your shoulder in your sleep
• Any history you may have of epileptic disorders

Physical examination plays a key role in diagnosing shoulder instability and any other related injuries. Doctors can perform a series of tests to diagnose both anterior (front) and posterior (back) shoulder instability, as well as mid-range instability. These tests have varying levels of specificity and sensitivity. An evaluation of overall ligament looseness, or ligamentous laxity, is also important, typically assessed using the Beighton score.

Testing for Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)

If a shoulder injury is suspected, several tests might be required to figure out what’s wrong. X-rays are often one of the first tests done. They can help doctors look for any broken bones or other damage related to conditions like a Bankart or Hill-Sachs lesion or fractures of the glenoid, the coracoid, or the greater tuberosity. These X-rays might be taken from several different angles, such as anteroposterior, axillary, or acromial outlet view. Some special views, like the West Point axillary view and the Stryker’s notch view, can help identify specific issues.

A Magnetic Resonance Imaging (MRI) test could also be done. This test is particularly good at identifying injuries to soft tissues, such as the glenoid labrum or capsuloligamentous structures. The MRI result might show things like blood in the joint fluid or detachment of the labrum from the anterior and inferior parts of the glenoid rim, both indicative of an acute Bankart injury. An MRI in the abduction and external rotation position can be better at detecting Bankart lesions than in the traditional neutral position. MRI is also good at identifying associated issues such as Perthe’s lesion, Anterior Labral Periosteal Sleeve Avulsion (ALPSA), Gleno-Labral Articular Disruption (GLAD), Superior Labral tear from Anterior to Posterior (SLAP), and Humeral Avulsion of Glenohumeral Ligament (HAGL).

An MR-arthrogram is another specific kind of MRI which is even better than a regular MRI at detecting labral tears. The specificity and sensitivity of this test are both extremely high, at 96% and 93% respectively.

Additionally, a Non-Contrast Computed Tomography (NCCT) scan with 3D reconstruction can be useful in assessing the extent of glenoid bone loss, the positioning of the articular surface, humeral bone loss, and the glenoid version. This test is particularly recommended when there’s suspicion of glenoid bone loss on the X-ray, the patient has had a lot of shoulder dislocations, or a large Hill-Sachs lesion is suspected. The NCCT scan with 3D reconstruction can also help identify whether a Hill-Sachs lesion is “On Track” or “Off Track”.

Glenoid and humeral bone loss measurements could be made on the 3D reconstruction for further information. This might involve calculations such as GT = 83% (D – d) and HSI = HS + BB to determine whether a lesion is On Track or Off Track.

Treatment Options for Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)

The course of treatment for a medical procedure called Bankart repair heavily depends on factors like the patient’s age, how physically active they are, their future activity plans, prior experiences with shoulder pain, recurring shoulder instability, and bone loss in the shoulder area.

Non-surgical treatment is usually most suitable for patients over the age of 30 who do not have obvious shoulder instability. This is especially true if they aren’t involved in vigorous activities. Non-surgical therapy may also be suitable for those who voluntary dislocate their shoulders or those with multi-directional instability, as long as their physical demands are low.

On the other hand, surgical intervention is most relevant for younger athletes, especially under 30 years of age, who have acute or primary traumatic anterior shoulder dislocations and intend to continue sports. Surgery is also considered if recurrent shoulder instability resulting from trauma limits daily activities, or if there’s a large rotator cuff tear or a significant bone defect. After non-surgical treatments, if persistent subluxation and pain still remain, surgical intervention could also be an option.

However, certain conditions may not make a patient a suitable candidate for surgery. For example, patients who are medically unstable, have seizure disorders, collagen disorders, atraumatic shoulder instability, a neurologic injury, or recurrent instability with post-traumatic arthritis aren’t ideal for surgical management.

The decision to perform surgery also weighs heavily on factors such as patient’s expectations, age, and sports involvement. In general, younger patients engaged in contact sports are more likely to undergo surgery. Factors such as glenoid bone loss and the type of Hill Sachs lesions are also considered. Different surgical techniques are opted for based on the extent of glenoid bone loss and risk of future instability.

What else can Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear) be?

An Anterior Labrum Periosteal Sleeve Avulsion Lesion (ALPSA) is a condition where the front lower part of the labrum – a type of cartilage in the shoulder joint – is forcefully pulled away. Even though the tissue around the shoulder blade remains undamaged, this lesion can heal in a wrong place, leading to shoulder instability.

A Perthes Lesion is somewhat similar. It’s when the front lower portion of the labrum detaches from the edge of the shoulder socket but partly stays connected due to the undamaged tissue around the shoulder blade. However, even though the separated labrum remains in its normal position, it becomes nonfunctional. As a result, the person will also have shoulder instability.

What to expect with Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)

Surgery using an arthroscope (a small camera) or traditional open surgery to fix anterior inferior labral lesions in the shoulder usually gives great results. The use of arthroscopy offers several possible benefits – it can restore the original anatomy of the glenoid labrum (the ring of cartilage around the shoulder socket), adjust the tension in the soft tissues selectively, offer improved range of motion, cause less pain after surgery, and it can save the subscapularis muscle (one of the four muscles of the rotator cuff) better than open surgery.

Functional results and getting back to the same level of sports performance are often better with arthroscopy for treating Bankart lesions (a specific type of labral tear). On comparing, the rate of return to the same level of sports activity is 71% after Bankart lesions are treated with an arthroscope, and 66% after open surgery.

Possible Complications When Diagnosed with Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)

Some complications can happen during the operation, known as perioperative complications. These include:

• Anchor failure
• Glenoid fracture, which is a break in the socket part of the shoulder joint
• Nerve injury (0.3% of cases) – this can involve the musculocutaneous or axillary nerves
• Formation of a hematoma, which is a collection of blood outside of a blood vessel
• Infection (0.2% of cases)

There can also be complications after the operation, known as postoperative complications. These differ depending on the repair method used.

For Arthroscopic Bankart Repair, complications can include:

• Recurrence – the Bankart injury reoccurring, with a rate between 10.7% and 13.1%. This recurrence rate is higher in younger patients, those who had a lot of dislocations before the surgery, those with significant bone loss, and those with excessive looseness in the lower shoulder joint.
• Decreased range of motion – particularly a reduction in the ability to rotate the shoulder outwards

For Open Bankart Repair, complications can include:

• Recurrence: The Bankart injury reoccurring, but with a lower rate of 8%
• Reduced range of motion- both external and internal shoulder rotations are reduced more than with Arthroscopic Bankart repair
• Rupture of the subscapularis, a muscle located on the front of the shoulder blade
• Prolonged operative time
• High incidence of sepsis, a severe infection that can spread throughout the body

Recovery from Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)

The rehabilitation process after an arthroscopic Bankart repair typically follows a schedule. For the first four weeks, patients are advised to keep their arm in a sling and only do passive external rotation exercises, but not to overdo it. From the fifth to the sixth week, they can stop using the sling and start overhead stretching using a rope and pulley. This phase also includes passive external rotation, but still, excessive movement should be avoided.

In the seventh and eighth weeks, more intensive exercises are introduced. Patients can now stretch their arms more and start doing strength-building exercises using a Thera band. The purpose of these exercises is to get half of the external rotation of the opposite shoulder.

From the fourth month up to the sixth, patients can go to the gym and do weight training. They continue doing strength-building exercises using Thera-band and restrained rotations. Once they reach six months after surgery, patients can resume their usual activities, including contact sports.

When it comes to the Open Latarjet Procedure, the recovery schedule is slightly different. The first six weeks involve sling immobilization and passive external rotation. Then for the next six weeks, patients focus on overhead and external rotation stretching. From the third month to the fourth, strength exercises are introduced. During the fourth to sixth month period, they can do weight training in the gym. After six months, they can return to fully unrestricted activities.

Preventing Anteroinferior Glenoid Labrum Lesion (Bankart Lesion) (Shoulder Joint Tear)

It’s important to teach athletes how injuries to the shoulder’s Bankart region occur, so they can avoid such injuries. It’s also essential to discuss with the patient the different ways to treat a Bankart injury, along with the benefits and disadvantages of each method. The patient needs to understand the significant role of physical therapy and a proper recovery plan in their healing process.

Patients are often advised to perform exercises that strengthen the shoulder muscles, and avoid movements that can cause shoulder dislocations. Strengthening exercises for the shoulder girdle may also be recommended. They should do their best to prevent further dislocations and wear protective clothing while playing sports to reduce injury risk.