Shoulder Labral Tear - Bankart Tear: Causes, Symptoms, and Treatment

What is a Bankart Tear?

A Bankart tear refers to a specific type of labral tear in the shoulder. The labrum is a ring of cartilage that provides stability to the shoulder joint by deepening the socket and acting as a cushion for the ball (humeral head) of the arm bone.

A Bankart tear occurs when the anterior (front) part of the labrum is torn due to the humeral head being dislocated from the shoulder socket. This injury often results from a traumatic dislocation of the shoulder, where the ball of the shoulder joint is forced out of the socket, stretching or tearing the labrum.

Causes of Bankart Tears

Bankart tears are most commonly caused by shoulder dislocations. The dislocation forces the ball of the shoulder out of the socket, potentially stretching or tearing the labrum in the front of the joint.

Other causes may include:

• Contact Sports: Football, rugby, and hockey, where collisions and forceful movements can result in shoulder injuries.

• Overhead Sports: Athletes who perform repetitive overhead motions, such as swimmers, throwers, and weightlifters, are at higher risk.

• Trauma: A direct blow to the shoulder or a fall onto an outstretched arm can cause a Bankart tear.

• Hyperlaxity (Loose Ligaments): Some individuals may have naturally looser ligaments, which can make the shoulder joint more prone to dislocations and tears.

Symptoms of a Bankart Tear

The symptoms of a Bankart tear can vary depending on the severity of the tear and whether the shoulder is unstable or dislocates frequently. Common symptoms include:

• Shoulder Instability: A sensation that the shoulder is "loose," "shaky," or might "slip out of place."

• Pain: Deep, aching pain in the front of the shoulder, especially during certain movements such as lifting, throwing, or overhead activities.

• Recurrent Dislocations: A history of repeated shoulder dislocations or subluxations, often triggered by specific movements or positions.

• Weakness: Difficulty using the shoulder for lifting or overhead movements due to instability or pain.

• Clicking or Popping: A clicking or popping sensation in the shoulder when moving it, which may indicate damage to the labrum or other joint structures.

• Limited Range of Motion: Difficulty moving the arm fully, particularly in activities that require overhead or rotational movement.

• Swelling and Bruising: Swelling or bruising around the shoulder joint, particularly following an injury or dislocation.

Diagnosing a Bankart Tear

To diagnose a Bankart tear, a healthcare provider will start by taking a detailed medical history and conducting a physical examination. During the physical exam, specific tests may be performed to assess the shoulder's stability and identify signs of labral injury.

Imaging tests, such as:

• X-rays: X-rays can identify fractures, dislocations, or bony abnormalities around the shoulder joint. However, X-rays cannot visualize soft tissue damage like a Bankart tear.

• MRI: An MRI (Magnetic Resonance Imaging) provides detailed images of the soft tissues, including the labrum. It is one of the most effective tools for diagnosing labral tears.

• MRA (Magnetic Resonance Arthrography): A special type of MRI that involves injecting a contrast dye into the shoulder joint to provide clearer images of the labrum and other joint structures.

• Arthroscopy: In some cases, a minimally invasive procedure using a small camera (arthroscope) is performed to view the inside of the shoulder joint. This is not only diagnostic but can also be used for surgical repair.

Treatment for a Bankart Tear

The treatment for a Bankart tear depends on the severity of the injury, the patient’s activity level, and whether there are additional shoulder issues (such as recurrent dislocations or weakness).

Non-Surgical Treatment

For less severe cases, or if surgery is not immediately required, non-surgical treatments are often effective. These may include:

• Rest and Ice: Resting the shoulder and applying ice can help reduce pain and inflammation, particularly after an acute injury or dislocation.

• Immobilization: A sling or brace may be used to support and protect the shoulder joint while it heals.

• Physical Therapy: A physical therapy program will focus on strengthening the muscles around the shoulder (particularly the rotator cuff and scapular muscles) to improve joint stability and prevent further dislocations. Proprioception exercises (balance and joint awareness) may also be included.

• Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be prescribed to manage pain and reduce inflammation.

• Activity Modification: Avoiding activities that place excessive stress on the shoulder joint, such as overhead or throwing motions, can allow healing to occur.

Surgical Treatment

In cases where conservative treatment does not resolve symptoms or the shoulder remains unstable, surgery may be recommended. Surgical options for a Bankart tear include:

• Arthroscopic Bankart Repair: The most common surgery for Bankart tears, this minimally invasive procedure involves small incisions through which a camera and surgical instruments are inserted to repair the torn labrum by reattaching it to the bone of the shoulder socket.

• Open Bankart Repair: In cases where the tear is more severe, an open surgery may be required, which involves a larger incision and direct repair of the labrum.

• Capsular Shift: In some cases, the shoulder capsule (the connective tissue surrounding the joint) may need to be tightened to help stabilize the shoulder and prevent future dislocations.

Rehabilitation and Recovery

After a Bankart tear repair, rehabilitation is crucial for a successful recovery. The rehabilitation process typically includes several phases:

• Phase 1: Immobilization and Protection: For the first 2-4 weeks after surgery, the shoulder may be placed in a sling to protect the repair. During this period, pain management and gentle range-of-motion exercises may be initiated.

• Phase 2: Restoring Range of Motion: Once the shoulder has healed enough, passive and active range-of-motion exercises are started to restore flexibility and mobility to the joint.

• Phase 3: Strengthening: As the shoulder becomes stronger, strengthening exercises will be introduced to target the rotator cuff and scapular stabilizer muscles.

• Phase 4: Functional Training: The final phase focuses on improving the functional use of the shoulder, including sport-specific exercises or activities that mimic everyday movements.

• Return to Sport/Activity: Athletes will typically begin sport-specific rehabilitation exercises as part of their return-to-play protocol. A gradual return to overhead or throwing motions is essential to ensure the shoulder remains stable.

The total recovery time varies but can take anywhere from 4 to 6 months, depending on the severity of the tear and the type of treatment used.

Prevention of Bankart Tears

While not all Bankart tears can be prevented, especially those caused by trauma or accidents, there are steps that can reduce the risk of shoulder injuries:

• Strengthen Shoulder Muscles: A strong rotator cuff and scapular muscles help stabilize the shoulder joint, reducing the risk of dislocations and labral tears.

• Proper Technique: Whether lifting, throwing, or participating in sports, using proper technique is critical for preventing stress on the shoulder joint.

• Avoid Overuse: Athletes who engage in repetitive overhead motions should take care to rest the shoulder and avoid overuse injuries.

• Wear Protective Gear: In contact sports, wearing appropriate protective equipment can help minimize the risk of traumatic injuries.

• Stretching and Mobility Exercises: Maintaining flexibility in the shoulder joint can help improve range of motion and reduce the risk of injury.

xpert Care at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, our team of expert physiotherapists can assist you in recovering from a Bankart tear. We provide a comprehensive treatment plan that includes pain management, rehabilitation, and pre- and post-surgery care.