bankart lesion thomas j kovack do. bankart lesion
TRANSCRIPT
Normal AnatomyNormal Anatomy Shoulder is a ball and socket type jointShoulder is a ball and socket type joint
Joint is surrounded by many ligaments Joint is surrounded by many ligaments and muscles to support the jointand muscles to support the joint
The labrum is a structure that attaches The labrum is a structure that attaches to the socket to help increase stability to the socket to help increase stability of the jointof the joint
InjuryInjury
With trauma to the shoulder the joint may With trauma to the shoulder the joint may dislocatedislocate
Most commonly dislocated joint in the Most commonly dislocated joint in the bodybody
Most common direction of dislocation is Most common direction of dislocation is anterior anterior
Bankart LesionBankart Lesion
As the humerus dislocates the As the humerus dislocates the labrum may be tornlabrum may be torn
This is referred to as a Bankart This is referred to as a Bankart LesionLesion
Named for the English surgeon who Named for the English surgeon who originally described itoriginally described it
Bankart LesionBankart Lesion
Occasionally a bony piece of the Occasionally a bony piece of the socket will fracture off with the socket will fracture off with the labrum; called a “bony Bankart” labrum; called a “bony Bankart” lesionlesion
Hill-Sachs lesionHill-Sachs lesion
After anterior dislocation can also After anterior dislocation can also have damage to the humeral head as have damage to the humeral head as glenoid drives into itglenoid drives into it
This is called a Hill-Sachs lesionThis is called a Hill-Sachs lesion
Bankart LesionBankart Lesion These lesions can make shoulder unstable These lesions can make shoulder unstable
and lead to recurrent instability and repeat and lead to recurrent instability and repeat dislocationsdislocations
Incidence of repeat dislocations is related Incidence of repeat dislocations is related to ageto age-patient < 20 yrs old 80-90%-patient < 20 yrs old 80-90%
-patients 20-30 yrs old 50-75%-patients 20-30 yrs old 50-75% -patients >40 yrs old lower rates of repeat -patients >40 yrs old lower rates of repeat
dislocations, higher rate of rotator cuff teardislocations, higher rate of rotator cuff tear
TreatmentTreatment
Can try non-operative treatment Can try non-operative treatment initiallyinitially
-Immobilization in external rotation -Immobilization in external rotation brace can allow labrum to brace can allow labrum to potentially heal in its normal potentially heal in its normal positionposition
TreatmentTreatment
Must wear brace for 3 weeks Must wear brace for 3 weeks continuouslycontinuously
After 3 weeks in the brace will begin After 3 weeks in the brace will begin physical thearpy to regain ROM and physical thearpy to regain ROM and strenghten shoulderstrenghten shoulder
Recurrence of InstabilityRecurrence of Instability
Despite non-operative treatment may have Despite non-operative treatment may have a recurrence of instabilitya recurrence of instability
Can lead to multiple dislocations and wear Can lead to multiple dislocations and wear of the anterior glenoidof the anterior glenoid
Recurrent dislocations can effect quality of Recurrent dislocations can effect quality of lifelife
-lead to apprehension and pain-lead to apprehension and pain
-inability to work-inability to work
-inability to participate in hobbies or sports-inability to participate in hobbies or sports
Operative TreatmentOperative Treatment
If having recurrent instability surgery If having recurrent instability surgery is indicatedis indicated
Benefits of surgery:Benefits of surgery:
-allows for stabilization of shoulder -allows for stabilization of shoulder and reduce chance of dislocationsand reduce chance of dislocations
-less apprehension and more -less apprehension and more confidence in range of motionconfidence in range of motion
-can improve quality of life and return -can improve quality of life and return to normal activitiesto normal activities
Operative TreatmentOperative Treatment
Surgery is done arthroscopicallySurgery is done arthroscopically
-small incisions with limited morbidity-small incisions with limited morbidity
-labrum is repaired using anchors and -labrum is repaired using anchors and suturessutures
-same day surgery-same day surgery
Post-opPost-op
After surgery you are placed in After surgery you are placed in external rotation brace for 3 weeksexternal rotation brace for 3 weeks
Come out of brace only to work on Come out of brace only to work on pendulum exercisespendulum exercises
Post-opPost-op
At 3 weeks begin working on active At 3 weeks begin working on active assisted range of motion with physical assisted range of motion with physical therapytherapy
10 weeks post op can begin gentle 10 weeks post op can begin gentle liftinglifting
At 6 months can return to activity as At 6 months can return to activity as toleratedtolerated
Results of SurgeryResults of Surgery
Most patients do well after surgeryMost patients do well after surgery
Satisfactory outcomes occur in greater Satisfactory outcomes occur in greater then 90% of patients in most studiesthen 90% of patients in most studies
Majority of patients are able to return to Majority of patients are able to return to pre-injury activitiespre-injury activities
Results of SurgeryResults of Surgery
Rate of recurrence after surgery Rate of recurrence after surgery estimated between 5%-15% estimated between 5%-15%
Recurrence is higher in:Recurrence is higher in:
-patients with bony bankart-patients with bony bankart
-patients with large Hill-Sachs lesion-patients with large Hill-Sachs lesion
-patients with generalized laxity-patients with generalized laxity((Boileau)Boileau)