What is a Bankart Repair?

The glenoid labrum is a fibrocartilage rim surrounding the edge of the glenoid fossa (shoulder socket). The shoulder labrum tear can occur in different ways. When a patient’s shoulder is dislocated, the anterior (front) portion of the labrum is often torn. This is called a Bankart tear or lesion, and it is the most common form of ligament injury to the shoulder.  Many of these patients will go on to experience recurring shoulder dislocation.  This will have a significant effect on the ability to participate in sport and sometimes also their work.

Recent technical advances combined with improvements in implant choice and suture material this arthroscopic shoulder surgery the procedure of choice. Current arthroscopic techniques are associated with failure rates of 5% to 10%, comparable to open procedures.

Advantages

The advantages of an arthroscopic shoulder surgery include less surgical morbidity, less postoperative pain, improved cosmesis and an easier, if not shorter, rehabilitation. Also, the anatomy can be better visualized at the time of surgery and if the tear is more extensive, particularly if it extends into the posterior part of the shoulder the arthroscopic procedure allows for this to be repaired at the same time.

Procedure
The goal of the procedure is to re-attach and tighten the torn labrum and ligaments of the shoulder. To do so, the surgeon inserts an arthroscope into a small incision and uses sutures and small bone anchors to secure the ligaments firmly in place. It is performed under a general anaesthetic and generally takes about an hour. The patient will be in the operating theatre complex for several hours as they need to be prepared for anaesthesia and then will need to wake up from the anaesthetic. Usually, an overnight stay is recommended post surgery.

Recovery

Following the procedure, the patient will be wearing a sling with a body belt. This may be a standard sling or an External Rotation sling, depending on the procedure performed.  The sling should be worn at night and when out and about for 3 weeks. The patient will then wean off the sling with the aid of a physiotherapist over the next 3 weeks. 

A nerve block is usually used during the surgery. This means that immediately after the operation the shoulder and arm often feel completely numb. This may last for a few hours. After this, the patient may experience soreness in their shoulder. Treatment for shoulder pain would include administration of painkillers during the hospital stay. These can be continued after they are discharged. Ice packs may also help reduce pain.

This operation is usually done through two or three 5mm puncture wounds. There will be no stitches, only small sticking plaster strips over the wounds. These should be kept dry until healed. This usually takes 5 to 7 days.

For the first three weeks most activities of daily living for example feeding, dressing, cooking etc must be carried out using the un-operated arm. The patient will not be able to drive for a minimum of 6 weeks. The surgeon will confirm when the patient may begin.

Anterior Dislocated Shoulder Treatment – What is the treatment ahead?

Being the most mobile joint in the body, the shoulder has more degree of freedom than any other joint of the body. But, this advantage also proves to be a disadvantage that makes the shoulder an easy joint to dislocate. The most common type of dislocation is the anterior shoulder dislocation. It usually results from forced abduction (shift away from position), external rotation and extension in the shoulder.

The largest group afflicted by this condition is the younger age group, who has either sustained injuries to the shoulder or has been aggressive during sporting activities. The second group is older patients who have been injured with a much milder violence.

When the shoulder dislocates, the nerves in the shoulder area can get stretched out. Some patients report stingers or numbness running down their arm at the time of the dislocation.

It is important to communicate with the doctor about the entire history of the injury. For example, if a visit to the emergency department had been made to have the shoulder reduced. If so, a radiograph of the dislocated shoulder will likely be the next course of action. If not, it needs to be known if they popped their shoulder back in or if it just went back in by itself. This can aid the treating physician in understanding how loose the shoulder has become.

Nearly 95% of shoulder dislocations result from a major traumatic event, and 5% result from less severe causes. Distinguishing the type and severity of the event is crucial in determining the true cause of the dislocation and decide the subsequent treatment path.

The preferred course of treatment is closed reduction with or without anesthesia. This non-invasive method is usually performed with light sedation and /or analgesia. In the process, the joint is manipulated back into anatomic alignment and immobilized. Occasionally general anesthetic may be required.

• MRI may be indicated sometimes, and it may show some associated lesions like hillsachs defect or labrum tear.
• Surgical repair of the labrum is required only in very active individuals like competitive athletes who have a higher risk of getting a recurrence of this problem.

The healing process from there on is a structured course of physical therapy aimed at reducing muscle wasting and maintaining mobility. 

Tips to aid shoulder pain treatment

After an exciting win, an Indian cricket fan’s adrenaline levels can be judged by how frantically they move their legs and shoulders in sync to the screams of joy. But as time passes by, age catches up. Cricketers retire to move into commentary boxes and the once energetic fans suffice their craze by good ole clapping. A quick switch to the news and we hear another athlete undergo surgery, while the swift urge to change channels made the shoulder scream in pain.

Injuries to the shoulder can occur from a wide number of reasons. Some of the common reasons cited are manual labour, sporting activities and repetitive movement. The shoulders tend to host a number of issues as time passes, especially after hitting the retirement mark. This is because soft tissues tend to degenerate with age. 

So, if your shoulder’s been more painful than productive of late, head straight to the doctor. Trust them to understand your issue and guide you through the ‘not so dreaded’ treatment of shoulder pain. And since the process can take a while and the general patience levels towards pain is quite well known, we bring to you some easy hacks. Hacks that aim to aid the treatment of shoulder pain with better ease.

1)      Icing:
Ice bags are extremely efficient in alleviating shoulder pain.
Reason – The cold temperature numbs the affected area which reduces pain and inflammation.
But beware; do not place ice directly on the sink. It can cause frostbite.

2)      Hot Compress:

      Just like icing,warm bath or hot bags help in easing out shoulder pain and other related problems. Though it is advised to opt for hot bags after 48 hours of the injury occurring. 

3)   Massage:

       A gentle massage eases out the stress and tension build up in your shoulder muscles.  It is also known to improve blood circulation and reduce swelling.

       Using oil like coconut oil, olive oil, sesame oil etc. provide better relief. But try to get massages            from professionals who know their way around it. 

4)      Stretching:
A likely cause of your shoulder ache can be stiff muscles. Poor posture or lack of use of the muscles can lead to stiffening. Sore and tight muscles respond well to stretching because it reduces muscle tension, promotes blood flow and improves flexibility. Just look out for sharp pain during stretching as they may be warning signs of bigger damage.

5)      Resting: 

       In most cases, the cause of shoulder pain is overuse or exertion. For example, lifting heavy objects over a long period of time can induce pain. Refrain from exerting activities for a few days can prove to be helpful.

        The above suggestions should hopefully help you ease you through the treatment of shoulder pain. But don’t stick to this only. Because a doctor is a better candidate for treatment than internet.