Bankart Tear

Injury to the Shoulder Labrum from Shoulder Dislocation

Shoulder injury
pascalgenest / Getty Images

A Bankart tear is a specific injury to a part of the shoulder joint called the labrum. The shoulder joint is a ball and socket joint, similar to the hip; however, the socket of the shoulder joint is extremely shallow, and thus inherently unstable. Being unstable means that the shoulder can more easily come out of the socket.

To compensate for the shallow socket, the shoulder joint has a cuff of cartilage called a labrum that forms a deeper socket for the ball of the top of the arm bone (humerus) to move within.

This cuff of cartilage makes the shoulder joint much more stable, yet allows for a very wide range of movements (in fact, the range of movements of your shoulder far exceeds any other joint in the body). When the body makes a deep bone socket, the joint is very stable, but it is much stiffer. The unique anatomy of the shoulder allows for a wide amount of motion, but reasonable good stablity.

Signs of a Bankart Tear

When the labrum of the shoulder joint is torn, the stability of the shoulder joint may be compromised. A specific type of labral tear is called a Bankart tear. A Bankart tear typically occurs when an individual sustains a ​shoulder dislocation. As the shoulder pops out of joint, it often tears the labrum, especially in younger patients. The tear is to part of the labrum called the inferior glenohumeral ligament. When the inferior glenohumeral ligament is torn, this is called a Bankart tear.

Typical symptoms of a Bankart tear include:

  • a sense of instability or giving out of the shoulder
  • repeat dislocations, often occurring more easily over time
  • catching sensations in the shoulder joint
  • aching of the shoulder and upper arm

Often patients will complain that they cannot trust their shoulder, fearing it may dislocate again.

A particular position that causes sensations of the arm wanting to give out is with the arm out to the side with the hand pointing upwards above the head. This movement of abduction and external rotation is a particularly vulnerable position for the shoulder joint. 

Diagnosis of a Bankart Tear

Most young patients (under the age of 30) who sustain a shoulder dislocation will sustain a Bankart tear; therefore, there is a high suspicion of this injury whenever a young patient dislocates their shoulder. On examination, patients will often have a sense their shoulder is about to dislocate if their arm is placed behind their head.

X-rays are sometimes normal, but they may show an injury to the bone called a Hill-Sachs lesion. This is a divot of bone that was injured when the shoulder dislocation occurred. An MRI may also be obtained in patients who have dislocated their shoulder. Bankart tears do not always show up well on MRI scans. When a MRI is performed with an injection of contrast solution, a Bankart tear is much more likely to be seen.

Treatment of a Bankart Tear

There are two general options for the treatment of a Bankart tear. One option is to allow the arm to rest, and the inflammation to subside with the use of a sling.

This is usually followed by physical therapy to regain motion of the extremity. The potential downside of this option is that people who dislocate a shoulder once are much more likely to dislocate the shoulder again.

The other option is to perform surgery to repair the torn labrum. When surgery is performed, the torn ligament is reattached to the socket of the shoulder. The results of surgery are usually very good, with over 90% of patients returning to their activities without any further dislocations. More and more commonly this surgery is being performed arthroscopically; however, there are some patients who should have a Bankart repair performed through a standard incision.

The problem with a Bankart tear is that individuals with this type of damage to the shoulder are much more likely to have repeat dislocations of the shoulder. Because the damaged labrum does not heal in perfect position, the shoulder joint is less stable. Younger patients, and those who participate in high-risk sports (such as ice hockey), are at especially high risk for having repeat dislocations. For this reason, many of these patients are advised to have surgery rather than nonsurgical treatment.

A Word From Verywell

Barkart tears are injuries associated with people who have had a shoulder dislocation and sustained a particular type of cartilage injury as a result. When a Bankart tear occurs within the shoulder, the ball and socket shoulder joint tends to be unstable, and repeat dislocations are a big concern. To prevent repeat dislocations, many people choose to undergo surgery to repair the Bankart tear.

Sources:

Streubel PN, Krych AJ, Simone JP, Dahm DL, Sperling JW, Steinmann SP, O'Driscoll SW, Sanchez-Sotelo J. "Anterior glenohumeral instability: a pathology-based surgical treatment strategy" J Am Acad Orthop Surg. 2014 May;22(5):283-94.

Continue Reading