Shoulder stabilisation (Bankart repair)

Shoulder instability can be a debilitating condition, significantly impacting your daily life and ability to participate in activities you enjoy. If you’ve experienced recurrent shoulder dislocations or a persistent feeling of your shoulder “giving way,” you might be dealing with an unstable shoulder. One of the most common causes of this instability, particularly after a traumatic dislocation, is a Bankart lesion – a tear of the labrum, the cartilage rim that deepens the shoulder socket. Fortunately, a highly effective surgical procedure known as a Bankart repair, a form of shoulder stabilisation surgery, can restore stability, reduce pain, and help you return to an active lifestyle.

This article will delve into the specifics of shoulder stabilisation (Bankart repair), exploring what causes shoulder instability, how a Bankart repair works, what the recovery process entails, and the potential benefits and risks associated with this procedure.

Understanding Shoulder Instability and the Bankart Lesion

To appreciate how a Bankart repair helps, it’s essential to understand the shoulder joint and the nature of instability.

• Anatomy of the Shoulder: Your shoulder is a marvel of mobility, a ball-and-socket joint where the head of your upper arm bone (humerus) fits into a shallow socket on your shoulder blade called the glenoid. This design allows for an extensive range of motion but also makes it inherently less stable than other joints. Stability is provided by:

  • The labrum: A ring of fibrocartilage that surrounds the glenoid, deepening the socket and acting like a bumper to keep the humeral head in place.
  • Ligaments: Strong bands of tissue that connect bones and help to hold the joint together, forming the shoulder capsule.
  • Muscles and Tendons: The rotator cuff muscles and other surrounding muscles play a crucial role in dynamic shoulder stabilisation.

• Causes of Shoulder Instability: Shoulder instability occurs when the structures designed to keep the humeral head in the glenoid are compromised. Common causes include:

  • Traumatic Injury: A forceful dislocation (where the ball comes completely out of the socket) or subluxation (partial dislocation) is a primary cause, often tearing the labrum and ligaments. This is common in contact sports or falls.
  • Repetitive Overhead Activities: Athletes involved in sports like swimming, tennis, or volleyball can develop instability due to repeated stress on the shoulder joint.
  • Ligamentous Laxity: Some individuals have naturally looser ligaments (are “double-jointed”), making their joints, including the shoulder, more prone to instability.

• The Bankart Lesion Explained: A Bankart lesion is a specific type of labral tear that occurs at the front (anterior) and lower (inferior) part of the glenoid. When the shoulder dislocates forward (the most common type of dislocation), the humeral head can tear the labrum away from the bone. Often, the inferior glenohumeral ligament, a key stabiliser, is also damaged. This torn labrum fails to provide its bumper effect, making the shoulder prone to further dislocations and instability. Sometimes, a piece of the glenoid bone may also fracture, known as a Bony Bankart lesion.

• Symptoms of Shoulder Instability: If you have an unstable shoulder, you might experience:

  • Recurrent shoulder dislocations or subluxations.
  • A sensation of the shoulder feeling loose or “giving way.”
  • Pain in the shoulder joint, especially with certain movements.
  • Apprehension or fear when placing the arm in specific positions (e.g., reaching overhead or behind the back).
  • Clicking, popping, or grinding sensations.
  • Reduced strength or function in the affected arm.

What is a Bankart Repair? The Surgical Solution

A Bankart repair is a surgical procedure designed to address the torn labrum and restore shoulder stabilisation. The primary goal is to reattach the detached labrum and tighten the stretched or torn ligaments back to the rim of the glenoid.

• Purpose of Bankart Repair: By repairing the Bankart lesion, the surgery aims to:

  • Restore the normal anatomy of the shoulder joint.
  • Deepen the socket, improving its ability to hold the humeral head.
  • Eliminate or significantly reduce the sensation of instability.
  • Prevent recurrent shoulder dislocations.
  • Allow a return to normal activities, including sports.

• Surgical Approaches:

  • Arthroscopic Bankart Repair: This is the most common method for shoulder stabilisation (Bankart repair). It’s a minimally invasive “keyhole surgery” performed through several small incisions (typically 2-4, around 5mm each). A tiny camera (arthroscope) is inserted into the shoulder joint, allowing the surgeon to view the internal structures on a monitor. Specialized small instruments are then used to debride (clean up) the torn edges of the labrum and prepare the bone. Suture anchors – small screws made of metal or a bioabsorbable material – are then inserted into the glenoid bone. The sutures attached to these anchors are passed through the torn labrum and ligaments and tied, securely reattaching them to the socket. Benefits of arthroscopic stabilisation often include less post-operative pain, smaller scars, a lower risk of infection, and potentially a quicker initial recovery compared to open surgery.
  • Open Bankart Repair: In some cases, an open surgical approach may be chosen. This involves a larger incision at the front of the shoulder. Open surgery might be preferred for more complex or extensive damage, revision surgeries (if a previous repair has failed), or if there’s significant bone loss that needs addressing simultaneously (though a Latarjet procedure is often considered for significant bone loss).

• The Procedure: Regardless of the approach, the fundamental steps involve:

  1. Anaesthesia: The surgery is usually performed under general anaesthesia, and a nerve block may also be used to help with pain relief after the surgery.
  2. Positioning: The patient is positioned to allow the surgeon optimal access to the shoulder.
  3. Assessment: The surgeon will thoroughly examine the inside of the shoulder joint to confirm the extent of the Bankart lesion and check for any other associated injuries (e.g., rotator cuff tears, cartilage damage).
  4. Repair: The torn labrum is mobilized, and the glenoid rim is prepared. Suture anchors are placed into the bone, and the sutures are used to pull the labrum back to its anatomical position and secure it firmly.
  5. Closure: The small incisions are closed with sutures or adhesive strips.

Most Bankart repair surgeries allow patients to go home the same day or after a short overnight stay in the hospital.

The Road to Recovery: Life After Bankart Repair

Successful shoulder stabilisation (Bankart repair) relies heavily on a structured post-operative rehabilitation program. Patience and commitment to physiotherapy are key.

• Immediate Post-Operative Period:

  • Pain Management: You will experience some pain after surgery, which can be managed with prescribed pain medication and ice packs applied regularly. The nerve block, if used, will provide significant pain relief for the first 12-24 hours.
  • Sling Use: Your arm will be placed in a sling, often with a body pillow, immediately after surgery. The sling protects the repair by limiting shoulder movement, especially external rotation. It’s crucial to wear the sling as instructed by your surgeon, typically for 3 to 6 weeks, even while sleeping. It should generally only be removed for prescribed physiotherapy exercises and personal hygiene.
  • Wound Care: Keep the incision sites clean and dry. Your surgeon will provide instructions on how to care for your wounds and when dressings can be removed or changed.

• Physiotherapy: The Cornerstone of Rehabilitation: Physiotherapy is vital for a successful outcome after a Bankart repair. Your physiotherapist will guide you through a phased rehabilitation program tailored to your specific needs and the surgeon’s protocol. The aims are to restore range of motion, strength, and function while protecting the surgical repair.

  • Phase 1 (0-6 weeks – Protection and Early Motion): The focus is on protecting the repair. Exercises will include gentle pendulum swings, passive range of motion (where the therapist moves your arm), and active-assisted range of motion. You’ll also be taught exercises for your neck, elbow, wrist, and hand to maintain their mobility. Shoulder stabilisation exercises focusing on scapular control may be introduced.
  • Phase 2 (6-12 weeks – Regaining Motion and Light Strengthening): Once the sling is discontinued (as per surgeon’s advice), the focus shifts to gradually increasing active range of motion. Light isometric (muscle contraction without movement) and gentle strengthening exercises for the rotator cuff and other shoulder stabilising muscles will begin.
  • Phase 3 (3-6 months – Progressive Strengthening and Endurance): Strengthening exercises will become more challenging. You’ll work on improving muscle endurance and control, and start more functional movements.
  • Phase 4 (6+ months – Return to Activity/Sport): This phase involves advanced strengthening, proprioceptive exercises (to improve joint awareness), and a gradual, sport-specific training program if you’re an athlete. Return to contact sports or high-impact activities is carefully managed and typically occurs between 6 to 9 months, once adequate strength, stability, and confidence are achieved.

• Timeline for Return to Activities:

  • Driving: Usually 6-8 weeks after surgery, once you are out of the sling and have regained sufficient control and pain-free movement of your shoulder. Always check with your surgeon or physiotherapist.
  • Work: Return to desk-based work may be possible within a few weeks, but manual labor or jobs requiring heavy lifting or overhead arm use will require a longer recovery period (3-6 months or more).
  • Sports: Non-contact sports may be resumed earlier (around 3-4 months) than contact or overhead sports, which often require 6-9 months or longer to ensure the shoulder stabilisation is robust.

Adhering to the rehabilitation protocol is crucial. Trying to do too much too soon can compromise the repair.

Potential Risks and Considerations for Shoulder Stabilisation (Bankart Repair)

While Bankart repair is a generally safe and effective procedure, like any surgery, it carries some risks.

• General Surgical Risks:

  • Infection (low risk with arthroscopic surgery).
  • Bleeding or haematoma (collection of blood).
  • Nerve or blood vessel damage (rare, but possible due to proximity to shoulder structures).
  • Blood clots (Deep Vein Thrombosis or Pulmonary Embolism – very rare for shoulder surgery).
  • Adverse reaction to anaesthesia.

• Specific Risks for Bankart Repair:

  • Recurrent Instability or Re-dislocation: While the surgery significantly reduces this risk (typically from over 50-90% without surgery down to 5-15% with surgery), it can still occur, especially if there’s a new significant injury or if the rehabilitation protocol isn’t followed.
  • Shoulder Stiffness (Frozen Shoulder or Adhesive Capsulitis): The shoulder can become stiff after surgery. This is why adherence to the physiotherapy exercises programme is so important to maintain and regain range of motion.
  • Hardware Issues: Problems with suture anchors are rare with modern implants but can include loosening or irritation.
  • Persistent Pain: Some patients may experience ongoing pain, though this is usually much improved compared to pre-surgery levels.
  • Nerve Irritation: Temporary numbness or tingling around the incision sites or in the arm can occur.

• Success Rates: Arthroscopic Bankart repair has a high success rate, with most patients experiencing significant improvement in shoulder stabilisation, reduction in pain, and the ability to return to their desired activities. Success is often defined by the absence of recurrent dislocations and improved functional scores.

• When to Consider Alternatives: If there is significant bone loss from the glenoid (socket), a Bankart repair alone may not be sufficient. In such cases, a procedure like the Latarjet procedure (which involves transferring a piece of bone to the front of the glenoid) might be recommended by your surgeon to provide additional bony stability. However, for most cases of traumatic shoulder instability due to a torn labrum without major bone loss, Bankart repair is the gold standard.

Taking the Next Step Towards a Stable Shoulder

Living with an unstable shoulder can be frustrating and limiting. Shoulder stabilisation (Bankart repair) offers a reliable solution to repair the damage, restore stability, and help you regain confidence in your shoulder.

Key Takeaways:

• Shoulder stabilisation (Bankart repair) effectively addresses shoulder instability caused by tears of the labrum (Bankart lesions).
• Arthroscopic techniques allow for a minimally invasive approach with generally good outcomes.
• A dedicated physiotherapy program is absolutely essential for achieving optimal recovery, strength, and long-term success after Bankart repair surgery.
• The procedure significantly reduces the risk of recurrent shoulder dislocations and allows a return to active lifestyles.

If you’re experiencing symptoms of shoulder instability, such as recurrent dislocations, pain, or a feeling of your shoulder giving way, it’s important to seek expert advice from a specialist. They can accurately diagnose your condition and discuss the most appropriate treatment options for you.

To discuss your shoulder concerns and explore if Shoulder stabilisation (Bankart repair) is the right option for you, book a consultation with Mr. David Shields today via this link: https://www.circlehealthgroup.co.uk/consultants/david-shields.

Alternatively, you can contact us for an appointment at info@theupperlimbclinic.co.uk.

Take the first step towards a stable and pain-free shoulder.