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BANKART LESION

The labrum of the shoulder joint can be torn because of a forceful shoulder dislocation. When the damage only involves the labrum, it is called a Bankart Lesion.


A Hill-Sachs lesion occurs when the lesion to the labrum presents simultaneously with a structural defect of the bone of the humeral head.

Causes

Mechanisms responsible for shoulder dislocation are amongst the causes leading to Bankart and Hill-Sachs lesions. These pathologies are most often diagnosed together with an anterior shoulder dislocation and in patients with recurrent shoulder dislocations.

Bankart and Hill-Sachs lesions are frequent in young men involved in contact sports and elderly women over 60 years due to falls.
Though anyone can sustain this injury, young men in their twenties are most susceptible.

 Possible causes of shoulder dislocations and lesions:
1) Car accidents
2) Sports collisions
3) Falls from sports (Falling and landing on one's the shoulder can lead to shoulder dislocations in athletes)
4) Falls not from sports (Falling off a ladder or tripping on a crack in the sidewalk)
5) Overuse injuries
6) Loose ligaments
7) Physical abuse
8) Risk factors

 Any sport or physical activity that predisposes to a shoulder dislocation presents a risk for Bankart and Hill-Sachs lesions. This includes individuals actively playing contact sports (football, rugby, hockey) and throwing activity (tennis, baseball, cricket). The increased incidence of falls onto the shoulder represents a higher risk in older people. The intrinsic poor vascularity of the glenoid labrum exposes this area to injury when strained. These pathologies can easily arise in patients with a congenital joint laxity, a condition named Ehlers-Danlos Syndrome that weakens the ligaments stabilizing the joints.

SIGNS AND SYMPTOMS OF A BANKART LESION
The most common symptom of Bankart and Sachs-Hill lesions is a feeling of instability of the shoulder joint particularly if these pathologies occur after repetitive dislocations. The patient may display the excessive translation of the humeral head within the glenoid joint. Pain and a catching sensation with shoulder subluxation are also frequently described. Patients often state that when moving the arm behind the head they feel that the shoulder is close to dislocating.

Symptoms of a Bankart lesion can include:
Pain: When reaching overhead, at night, or with daily activities. Throwing a ball may also cause pain.

Instability and weakness: The shoulder may "just hang there," pop out of the joint, or feel too loose.

Limited range of motion: Sudden difficulty moving the shoulder in any direction may indicate a tear.

Unusual noises or sensations in the shoulder: Grinding, catching (not moving fluidly), locking in place, or popping can all be symptoms of torn tissue getting caught in the joint.

Diagnosis
A medical history sets the beginning of a clinical investigation to evaluate the possible causes, injuries, and previous shoulder dislocations that have led to a recurrent shoulder dislocation. A high-energy trauma event, particularly in active young individuals, presents a higher risk for a Bankart or Hill-Sachs lesion, thus requiring thorough medical analysis. The clinical examination provides a good indication for a dislocated shoulder and possibly other associated pathologies. Specific functional tests employed include the apprehension test, relocation test, and sulcus sign. However, radiological imaging is required for the exact diagnosis of a Bankart and Hill-Sachs lesion. A Bankart lesion of the labrum is visualized at best by MRI using a contrast agent. X-rays and CT scans do not detect easily a Bankart lesion as it involves soft tissue but is useful to diagnose a Hill-Sachs lesion to the humeral head and possible collateral fractures.

Treatment
Nonoperative treatment
The first approach of conservative treatment for a Bankart lesion due to shoulder dislocation is a closed reduction of the shoulder followed by temporary immobilization with a sling until the inflammation has subsided.
The patient requires treatment with pain killers and NSAID’s in the acute phase and subsequently undergo intensive physical therapy. However, with non-operative treatment, there is a higher risk of recurrent dislocations. If the shoulder dislocates again, surgery is needed.

Surgical treatment
If your shoulder continues to dislocate or feel unstable, see a Bankart Repair Doctors in Noida. Your Bankart Repair Doctors in Noida may use X-rays, an MRI, and/or a thorough physical exam to confirm a tear and determine whether you also have a bony lesion.


Depending on the cause of your shoulder instability (is it a traumatic injury, or a chronic condition that arose on its own?), you may be prescribed an exercise program and/or surgery to stabilize the shoulder joint.

Shoulder Arthroscopy
Most often, minimally invasive procedures can be used to repair the labrum. Your Bankart Repair Doctors in Noida can use a scope and small surgical tools to locate and examine the tear, remove damaged fragments, and trim them.
Your Bankart Repair Doctors in Noida will place 2–3 anchors on the bone near your tear. Sutures attached to the bone are pulled tight, reattaching the torn piece of the labrum to the bone.

Open surgery
In some cases, best orthopedic doctor in delhi ncr may prefer to use open surgery for this procedure.

Which method your Bankart Repair Doctors in Noida chooses depends on variables like the type and location of your injury, the condition of your tissue, and how much additional damage you may have sustained.



Depending on the extent of your injury, other recommended surgical procedures might include:
· Ligament re-attachment
· Bone reshaping or grafting to add stability to the glenoid (socket)
· Reshaping, building up, or thickening of the glenoid labrum cartilage
· Capsule and ligament tightening to repair looseness and add stability

Rehabilitation
Several exercises are available to strengthen the rotator cuff and the musculature of the shoulder and shoulder blades. Stretching is useful to restore flexibility and the range of movement of the shoulder joint. Following Bankart repair treatment in noida, the patient wears a sling for about three weeks until physiotherapy begins. In the recovery phase applications of cold pads, administration of pain killers and anti-inflammatory therapy with NSAIDs is standard rehabilitative management to improve symptoms.

Physiotherapy consists of several methods:
  • Massage
  • Ice/heat treatment 
  • Joint mobilization
  • Physical exercise (pendular movements, shoulder shrug, rotation)
  • Education in sport and daily activities
  • Return to sport plan
  • Anti-inflammatory treatment (NSAIDs)
Prevention
The best prevention for a shoulder dislocation and consequent Bankart and Hill-Sachs lesions consists of physical training to strengthen the muscles around the shoulder and core. It is also recommended soon after recovery to avoid excessive training or intense activities potentially leading to recidivism.

In patients with increased risk due to strenuous sports activities, it is advised to wear proper safety equipment (braces) and padding during training. Where possible avoid falls in the elderly to prevent shoulder dislocation. Contact us for Bankart repair in noida.
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