Bankart procedure

Definition

A Bankart procedure, also called a Broca-Perthes-Bankart procedure, is really a surgical technique for the repair of recurrent shoulder joint dislocations. Within the procedure, the worn out ligaments are re-attached to the proper place in the shoulder joint, using the objective of rebuilding normal function.

Purpose

The shoulder is the junction of three bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). The shoulder joint (glenohumeral joint) is the consequence of the top of the humerus bone fitting in the cavity of the shoulder blade (glenoid cavity), the joint being held together through the labrum, a rim of soft tissue that surrounds the glenoid. As a result of excessive force being put on the arm, the top from the humerus might be pressured from the glenoid cavity (dislocation), and the supporting ligaments of the shoulder joint may be split. These ligaments may recover so the shoulder regains its stability. However, sometimes the ligaments do not heal, making the shoulder unstable or painful. This problem is referred to as traumatic instability of the shoulder, traumatic glenohumeral instability, or a Bankart lesion. The safe and secure re-attachment of the torn ligaments towards the tip of the glenoid from which these were detached may be the aim of a Bankart process of traumatic glenohumeral instability. The surgery has got the advantage of allowing patients to resume many of their activities of daily living while the repair is curing. The surgery also reduces the undesirable joint stiffness related to such injuries.

Description

Generally, shoulder surgery can be carried out in two fundamentally various ways: either using closed surgical methods (arthroscopic surgery) or using open surgical techniques. A wide open surgery Bankart procedure is performed under general anesthesia. The individual is positioned inside a 30-degree inclined chair position using the arm free over the fringe of the operating table. A bag is placed under the center from the shoulder blade of the shoulder being operated onto offer the shoulder and to push the shoulder blade forward. Prepping and draping permits the arm to become freely portable and allow a good view of the surgical field. The whole upper limb is ready with antiseptic. A test under anesthesia is performed to confirm the precise nature of the instability. The doctor makes a long incision to gain use of the joint, often cutting through the deltoid muscle to operate about the inner structures from the shoulder, and proceeds to stitch the joint capsule to the detached labrum tissues.

The arthroscopic Bankart method attempts to imitate the open Bankart procedure. Arthroscopy is a microsurgical technique through which the doctor may use an endoscope to appear through a small hole into the shoulder joint. The endoscope is a tool the size of a pen that includes a tube fitted having a light and a miniature video camera, which transmits a picture from the joint interior to some television monitor. The detached the main labrum and also the associated ligaments are reattached to bone across the rim of the glenohumeral cavity via a small "keyhole" incision. This is accomplished with little disruption to the other shoulder structures and with no need to detach and reattach the overlying shoulder muscle (subscapularis).

Demographics

The shoulder is easily the most commonly dislocated major joint following severe trauma, such as an auto collision or perhaps a fall onto an outstretched arm. Some 96% of dislocations involve the front of the shoulder (anterior), with 1-3% occurring in the back (posterior). Falls and car accidents are common causes of first-time dislocations, but recurrent dislocations in many cases are because of seemingly inoffensive activities such as raising the arm over the head, or combing hair. Shoulder dislocations are more common in males than females, as well as in teenagers.

Risks

The following risks are found in Bankart procedure:

• Perioperative: Nerve injury during surgery and poor keeping anchor sutures.
• Within six weeks after surgery: Wound infection and rupture of the repair.
• Between 6 weeks and 6 months: Shoulder stiffness, recurrence of instability, failure of the repair resulting in shoulder weakness, failure of the anchor sutures.

Diagnosis/Preparation

The physician diagnoses a Bankart lesion from the patient's history, by carrying out a comprehensive physical study of the joint, and taking the proper x-rays. The examination often discloses that the head from the humerus slips easily from the joint socket, even when it is pressed into it. This is called the "load and shift test." X-rays may also disclose that the bony lip of the glenoid socket is rounded or deficient, or how the head of the humerus is not centered within the glenoid cavity.

A diagnostic arthroscopy can also be often used to confirm the presence and extent of the shoulder instability. In this procedure, a thin fiber-optic scope is placed to the shoulder joint space to permit direct visualization of its internal structures. An electromyogram may also be acquired when the treating physician suspects the potential of nerve injury. Patients should deal with any health condition in order to maintain the best possible condition with this procedure. Smoking ought to be stopped a month before surgery and not started again for at least three months afterwards. Any heart, lung, kidney, bladder, tooth, or gum problems ought to be managed before surgery. The orthopedic doctor needs to be informed of health issues, including allergies and the non-prescription and prescription drugs getting used through the patient.

Morbidity and mortality rates

Surgery for anterior dislocation from the shoulder fails in one out of 10 to 1 from 20 cases, with a higher incidence of failure in arthroscopic Bankart procedures in comparison with outdoors surgical method. There is also a higher occurrence of failure in patients who smoke, people who begin using their shoulder powerfully very early after the repair, and in those with much unfastened ligaments.

Normal results

Normal results for a Bankart procedure include:

• normal upper arm strength and endurance
• good control of pain and inflammation
• normal shoulder range of motion

The classic treatment of repeated shoulder dislocations remains open surgical Bankart repair. This approach has a success rate as high as 95% in effectively removing shoulder instabilities.

Alternatives

Surgical

The Bristow procedure is definitely an alternative surgical procedure used to treat shoulder lack of stability. In this method, the coracoid process (a long, curved projection from the scapula) using its muscle attachments is used in the neck from the scapula and helps to create a muscle sling at the front of the glenohumeral joint.

Non-surgical

Shoulders could be stabilized and strengthened with special exercises. During the early phases of such physiotherapy programs, the patient is taught to make use of the shoulder only in the most stable positions-those in which the humerus is elevated within the plane from the scapula. As coordination and self-confidence improve, gradually less stable positions are tried.

Who performs the process and where could it be performed?

A Bankart procedure is conducted in a hospital setting by an orthopedic doctor focusing on shoulder instability problems.

Aftercare

Exercises are generally started on your day following surgery with instructions from the physical therapist, five times daily, including assisted flexion and external rotation of the arm. Another arm can be used to support the arm that went through surgery until it may carry out the exercises alone. The individual is permitted to perform many activities of daily living as tolerated, but without lifting anything heavier than the usual glass or plate. If a patient cannot adhere to restricted use of the shoulder, the arm is saved in a sling for three weeks. Otherwise, a sling is used just for comfort between exercise sessions and to protect the arm when the patient is out in public places and at night while sleeping. Driving is allowed as soon as two weeks after surgery, when the shoulder can be used comfortably, especially if the patient's car has automatic transmission. At eight to 10 weeks, the individual can usually continue light, low-risk activities, such as swimming and jogging. If involved with sports, the patient may return to training at 3 months. Hospital physiotherapy is rarely prescribed in support of in cases of delayed rehabilitation or shoulder stiffness.

Questions you should ask the doctor

• How long does it take to get over the surgical procedure?
• How many Bankart procedures would you carry out each year?
• What are the different types of surgery readily available for shoulder instability?
• Will surgery cure my shoulder condition so that I might continue my activities?
• Are there any options to surgery?
• Can medicines help?