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A Bankart lesion is a tear specific to the anterior/inferior portion of the labrum, where the labrum is torn off the glenoid, caused through dislocation of the shoulder and tearing of the inferior glenohumeral ligament. When dislocating your shoulder, it is very common to for you to cause a Bankart lesion resulting in an unstable shoulder which could lead to further dislocation. Dislocations are separated into three categories:
- TUBS – Traumatic, Unilateral, Bankart lesion, Surgery. This involves the shoulder being subject to an excessive force, strong enough to pull the shoulder out of the joint tearing the labrum e.g. rugby tackle. The shoulder would dislocate in one direction only (anterior/posterior/inferior) and need to be reduced (relocated).An anterior stabilisation is performed whereby the Bankart lesion is repaired and the glenohumeral ligament restored.
- AMBRI –Atraumatic, Multi-directional, Bilateral, Rehabilitation, Inferior Capsular shift. This form of injury is caused by muscular weakness and ligamentous laxity. Here, you would experience multiple dislocations in different directions and would often happen to both shoulders. Patients usually benefit from a comprehensive rehabilitation programme however surgery can be performed (capsular shrinkage/anterior capsular shift) if there were no improvement
- Positional Non-traumatic dislocations – here you will be able to actively dislocate and relocate your shoulder with no history of trauma. Again, a comprehensive rehabilitation programme is undertaken with capsular shrinkage surgery a final option.
Above: Trigger pont massage of the msucels in the left shoulder Physiotherapy before Bankart Repair and Anterior Stabilisation of the Shoulder
Physiotherapy prior to surgery is a highly useful intervention. It will help strengthen the joint, helping to prevent further dislocations, and provide a solid platform for post surgical rehab helping to maximise rehab potential. Treatment options available include:
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Acute management of symptoms |
- Muscular strengthening programme
- Proprioceptive training
- Manual therapy
- Advice and post surgical management
Symptoms following Bankart Repair and Anterior Stabilisation of the Shoulder
Following Bankart repair and anterior stabilisation surgery, your shoulder will be placed in a protective sling for 3 weeks to help protect the new shoulder and aid recovery. During this time you will be limited to the amount of movement allowed as well as the use of your arm. Symptoms that you may experience include:
- Pain
- Swelling
- Bruising
- Stiffness
Physiotherapy following Bankart Repair and Anterior Stabilisation of the Shoulder
Following shoulder replacement surgery a well planned physiotherapy programme designed with Physio.co.uk is critical for the success of the operation. Physio.co.uk will provide a thorough assessment and explanation of treatment as well as design a personal rehabilitation programme. Treatment will initially focus on acute management following surgery and progress on to regaining strength, range of movement and function.
Weeks 1-3
Initial treatment with Physio.co.uk will concentrate on minimising post operative complication, reducing acute symptoms and the initiation of movement. Treatment will include:
- Cryotherapy
- Pain management
- Postural education
- Elbow, wrist, and hand range of movement exercises and strengthening
- Passive shoulder range of movement
- Progress on to active assisted range of movement exercises
- Pendulum exercises
- Scapular setting
- Isometric strengthening
- Soft tissue release
- Wound Management
- Advice and education
Weeks 4-6
At this stage, you will be weaned off your sling and encourage to increase your rehabilitation in order to improve range of movement and begin strengthening. Also, attention will be paid to restoring normal biomechanical movements through stability and proprioceptive exercises. Physio.co.uk will develop your programme with attention to personal requirements so that your surgery milestones are met. Treatment will include:
- Increased passive and active assisted range of movement in all directions
- Begin active range of movement
- Scapular Stabilising
- Soft tissue massage
- Capsule stretching
- Strengthening
- Closed chain activities
- Proprioceptive training
- Scar management
Weeks 7-12
Following week 7 Physio.co.uk will focus on a continuation and progression of exercises. Rehabilitation will begin to include specific exercises needed to perform functional activities and be directed to attaining full range of movement, improving muscular strength and endurance. Treatment will consist of:
- Full scapular control
- Increased active and passive range of movement to attain full range
- Rotator cuff strengthening
- Shoulder muscle strengthening
- Stretching
- Soft tissue massage
- Muscular endurance
- Increased proprioceptive training – PNF patterns
- Joint mobilisations
- Encourage functional activities
- Begin sports specific exercises (non contact moving to contact)
- Plyometric and perturbation exercises
Weeks 12+
Following 12 weeks of intense physiotherapy with Physio.co.uk you will have regained range of movement and significantly improved muscular strength, endurance and control. With full recovery between 4-6 months Physio.co.uk will intensify treatment, providing a comprehensive long term rehabilitation programme so that you are able to return to full sporting and social activities and maximise functional use of your arm.
- Attainment of full range of movement
- Advanced strengthening of rotator cuff throughout range
- Advanced shoulder muscle strengthening
- Advanced proprioceptive exercises
- Functional training
- Long term management
Summary
Bankart repair and anterior stabilisation of the shoulder is a common surgical operation to repair the labrum and ligamentous structures of the glenohumeral joint. The most common form of injury is through dislocation, usually through trauma, which will tear the inferior portion of the labrum as well as the inferior glenohumeral ligament (stability structures). These injuries are common among sports players due to the increased risk of trauma and surgery is needed in order to prevent repeat dislocations. Physiotherapy is an essential component of rehabilitation and Physio.co.uk will provide a comprehensive and intense treatment programme to ensure the full recovery of movement, strength and functional use of your arm. Call Physio.co.uk now on 0330 088 7800 for more information or to book an appointment please contact us.
