Bankart repair for unstable dislocating shoulders: Surgery to anatomically and securely repair the torn anterior glenoid labrum and capsule without arthroscopy can lessen pain and improve function for active individuals.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Friday, October 16, 2009
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Figure 1 - Shoulder dislocation – the humeral head is held in the glenoid socket by compression from the rotator cuff Shoulder dislocation – A-P and Axillary x-ray views Shoulder dislocation – apical oblique x-ray view Shoulder dislocation – apical oblique view showing a Hill Sachs defect of the humeral head and a defect of the anterior inferior rim of the glenoid Shoulder dislocation – Bankart lesion with repair sutures placed through the bone edge Shoulder dislocation - Failed arthroscopic Bankart repair Shoulder dislocation – fracture of the anterior inferior glenoid lip Shoulder dislocation – bone graft held in place with screws to replace the anterior – inferior glenoid bony defect Shoulder dislocation – bone block secured in place to replace glenoid bony defect SummaryOverview
The normal shoulder
is a marvel of mobility and stability. It provides more motion than any other
joint in the human body, yet the humeral head (ball of the shoulder joint)
remains precisely centered in the glenoid (the socket of the joint) throughout
the wide range of shoulder activities. One of the main stabilizing mechanisms
is concavity compression, in which the head of the humerus is held into the
glenoid concavity by the action of the rotator cuff (much like a golf ball is
held into the concavity of a golf tee).
The figure shows the humeral head, the glenoid, and one of the muscles
of the rotator cuff. The concavity of the shoulder socket is deepened by a
fibrous ring, known as the glenoid labrum (see movie 1). The glenoid labrum
greatly increases the stability of the shoulder (see movies 2 and 3). Another
stabilizing mechanism is ligament restraint in which the motion of the shoulder
is kept within the proper range by ligaments that span the joint (see movie 4).
The glenoid labrum
and the ligaments can be torn when the arm is forced backwards, allowing the
humeral head to dislocate from the glenoid. If the labrum and the ligaments do
not heal, the shoulder may continue to be unstable, allowing the ball to slip
from the center of the glenoid, even with minimal force.
When recurrent shoulder dislocations or feeling of instability
interfere with the comfort and security of the shoulder, a repair of the
ligaments and labrum by an experienced shoulder surgeon can usually restore the
stability of the joint. QuickTime movies
The patient with an
unstable shoulder requires a thorough history and physical examination along
with proper x-rays.
The most common
form of ligament injury is the Bankart lesion, in which the ligaments are torn
from the front of the socket. A solid surgical repair requires that the torn
tissue be sewn back to the rim of the socket. Failure to secure this lesion solidly
can result in failure of the repair.
If the glenoid bone is deficient, the
shoulder may benefit from a surgery to restore the lost bony anatomy.
Surgery for shoulder dislocations at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA
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