Arthroscopic Shoulder Stabilization-Labral Repair, BANKART Repair
Shoulder instability is a chronic condition that causes frequent dislocations of the shoulder joint. A dislocation occurs when the end of the humerus (the ball portion) partially or completely dislocates from the glenoid (the socket portion) of the shoulder. A partial dislocation is referred to as a subluxation whereas a complete separation is referred to as a dislocation. The repeated dislocation of the humerus out of its socket is called chronic shoulder instability. A tear in the labrum or rotator cuff and ligament tear in the front of the shoulder (a Bankart lesion) may lead to repeated shoulder dislocations.
Indications for Shoulder Stabilization
When conservative treatment options such as medications, rest, and ice application fail to relieve shoulder instability, your surgeon may recommend shoulder stabilization surgery.
Shoulder Stabilization Procedure
Shoulder stabilization surgery is done to improve stability and function to the shoulder joint and prevent recurrent dislocations. It can be performed arthroscopically, depending on your particular condition, with much smaller incisions. Arthroscopic stabilization is a surgical procedure to treat chronic instability of the shoulder joint.
Arthroscopy is a minimally invasive surgery and is performed through two tiny incisions (portals), about half-inch in length made around the joint area. Through one of the incisions, an arthroscope (small fiber-optic viewing instrument) is passed. A television camera attached to the arthroscope displays the images of the inside of the joint on the television monitor, which allows your surgeon to look at the cartilage, ligaments and the rotator cuff while performing the procedure. A sterile saline solution is pumped into the joint which expands it and gives a clearer view to the surgeon. Bone spurs, defects or tissue tears will be identified.
Your surgeon makes use of tiny surgical instruments which are passed through the other incisions to treat the condition. Any tear in the rotator cuff will be sutured or stapled. The sutures will be held in place with help of a small anchor which is drilled into the upper part of the humerus. Further, a thermal shrinkage device may be used in order to make the ligaments tight and prevent instability.
Postoperative Care for Shoulder Stabilization
Following the procedure, your surgeon may advise the use of a continuous passive motion machine to prevent stiffness and improve range of motion of the shoulder joint. Pain medications will be prescribed to keep you comfortable. A shoulder sling can be worn for 4-6 weeks to immobilize and facilitate healing. Postoperative rehabilitation program including strengthening exercises will be advised for 6-9 months. You will be able to participate in sports in about 18 to 36 weeks after the surgery.
Advantages of Shoulder Stabilization
The major benefits of arthroscopic stabilization as compared to open repair of instability are that it gives a chance to identify and treat coexisting diseases, lesser pain and complications, combined with shorter hospital stay.
Risks and Complications of Shoulder Stabilization
As with any surgical procedure, there may be certain risks and complications involved and include infection of the surgical wound, post-operative stiffness, risk of arthritis, muscle weakness and injury to the nerves and blood vessels.
What is a Bankart Tear?
The shoulder joint (glenohumeral joint) is a ball and socket joint, where the head of the upper arm bone (humerus) attaches to the shoulder socket (glenoid cavity). The shoulder socket is extremely shallow and therefore needs additional support to keep the shoulder bones from dislocating. The labrum, a cuff of cartilage that encircles the shoulder socket, helps serve this purpose by forming a cup for the humeral head to move within. It provides stability to the joint, enabling a wide range of movements.The labrum can sometimes tear during a shoulder injury. A specific type of labral tear that occurs when the shoulder dislocates is called a Bankart tear. This is a tear to a part of the labrum called the inferior glenohumeral ligament and is common in younger patients who sustain a dislocation of the shoulder. A Bankart tear makes the shoulder prone to repeat dislocation in patients under 30 years of age.
How is a Bankart Tear Diagnosed?
Your physician will ask about your medical history and perform a thorough physical examination of your shoulder. Your doctor may recommend an additional X-ray or an MRI.
What are the Treatment Options?
Conservative treatment measures for a bankart tear include rest and immobilization with a sling followed by physical therapy. Bankart repair surgery is indicated for a bankart tear, when conservative treatment measures do not improve the condition, but instead results in repeated shoulder joint dislocation.
Arthroscopic Bankart Repair Procedure
Bankart surgery can be performed by a minimally invasive surgical technique called arthroscopy.
During an arthroscopic Bankart procedure, your surgeon makes a few small incisions over your shoulder joint. An arthroscope, a slender tubular device attached with a light and a small video camera at the end is inserted through one of the incisions into your shoulder joint. The video camera transmits the image of the inside of your shoulder joint onto a television monitor for your surgeon to view. Your surgeon then uses small surgical instruments through the other tiny incisions to trim the edges of your glenoid cavity. Suture anchors are then inserted to reattach the detached labrum to the glenoid. The tiny incisions are then closed and covered with a bandage.
Arthroscopy causes minimal disruption to the other shoulder structures and does not require your surgeon to detach and reattach the overlying shoulder muscle (subscapularis) as with the open technique.
Postoperative Care for Arthroscopic Bankart Repair
The following are the post-operative care details following arthroscopic Bankart repair:
- After your surgery, you will spend about an hour in the recovery room.
- Your physical therapist will start you on shoulder exercises the day following your surgery to strengthen and improve the range of motion of your shoulder joint.
- You will be allowed to perform your daily activities as tolerated, but without lifting objects heavier than a plate or glass while you heal.
- Your arm may be placed in a sling for three weeks to restrict use of your operated shoulder.
- You may resume light low-risk activities, like jogging and swimming 8 to 10 weeks after surgery, and may be advised to avoid contact sports for some time.
Risks and Complications of Arthroscopic Bankart Repair
Arthroscopic Bankart repair is a relatively safe procedure. Being minimally invasive it is associated with fewer risks and a quicker recovery. Some of the potential risks include:
- Injury to adjacent nerves or blood vessels
- Stiffness of the joint