Labral Tear

LABRAL TEAR SLAP LESION/BANKART LESION

 

Anatomy

The shoulder joint involves three bones: the shoulder blade (scapula), the collarbone (clavicle) and the upper arm bone (humerus).

The head of the upper arm bone (humeral head) rests in a shallow socket in the shoulder blade called the glenoid. The spherical head of the upper arm bone is much larger than the socket. A soft fibrous tissue rim called the labrum surrounds the socket to help extend the depth of the socket.

It is made of fibrocartilage. stabilise the joint. The rim deepens the socket by up to 50 percent so that the head of the humerus fits better. In addition, it serves as an attachment site for several important ligaments. It is these ligaments that contribute to the stability of the joint, preventing a dislocation, both by mechanically becoming taught in certain positions of the arm, and by providing information to the conscious brain about the position and movement of the shoulder via tiny ‘sensors’- this process is called proprioception.

Tears can be located either above (superior) or below (inferior) the middle of the glenoid socket. A SLAP lesion (superior labrum, anterior (front) to posterior (back) is a tear of the rim above the middle of the socket. A tear of the rim below the middle of the glenoid socket that also involves the inferior glenohumeral ligament is called a Bankart lesion. Tears of the glenoid rim often occur with other shoulder injuries, such as a dislocated shoulder (full or partial dislocation).

SLAP LESION

The top of the labrum is a vulnerable area to injury. The long head of biceps hooks over the top of the humerus so if the arm is forcefully pulled across the body or if the biceps forcefully contracts as in throwing a ball hard, especially overhead, the labrum at this point, can be pulled away.

 

BANKART LESION

The part of the labrum that lies anterior( front of ) and inferior (bottom of) to the glenoid ( socket side of the shoulder joint) is prone to injury in an unstable shoulder joint; and liable to be torn off the edge of the glenoid bone following anterior 9or anterior- inferior) dislocation.


Other injurious Mechanisms include:

a) Fall onto an outstretched arm
b) Direct blow to the shoulder.
c) Sudden pull as in trying to lift/drag a heavy object.
d) Repetitive throwing/racket sports.

 

Signs and Symptoms

• Pain, usually with overhead activities or fast movements
• Night pain/difficulty sleeping on affected side.
• Cracking noises/grinding feeling.
• A sense the shoulder may pop out.
• Decreased range of movement.
• Loss of strength
• A dead arm feeling.

Diagnosis

• Physical examination.
• CT (computerised tomography)
• MRI scan
• MRI Arthrography

Treatment

• Anti-inflammatory drugs.
• Rehabilitation exercises to strengthen the rotator cuff.
• Surgery

If the glenoid rim alone is torn, this can be repaired by suturing. If further
instability has occurred capsular shrinkage/plication may be needed.

SLAP Repair Arthroscopic

There are three portals, one posteriorly for the arthroscope, one anteriorly for the arthroscope and arthroscopies tools and one below this as an outflow portal.

The purpose is to reattach the detached artero-inferior labrum (Bankart lesion) to the glenoid with minimal restriction of external rotation.

The glenoid socket in the area of the lesion is roughened to produce an improved surface for the repair. Suture anchors are inserted into pre-drilled holes in the margin of the glenoid. These embedded anchors grip the bone and allow the labrum to be tightened against the glenoid via a suture pressed through both the labrum and anchor.

BANKART REPAIR OPEN
Purpose

To repair the detached antero-inferior labrum ( Bankart Lesion) to the glenoid with minimal restriction of external rotation.

 

Indications

Patients with a Bankart Lesion and recurrent dislocation of the shoulder joint ( glenohumeral joint)

 

Skin Incisions

Delto pectoral

 

Approach

Superficial muscles are separated and deep muscles divided. The capsule of the joint is opened. All these structures are repaired at the end of the proceedue.

Procedure

The edge of the glenoid is roughened to produce an improved surface for the repair.A number of either Titanium or Bioabsorbable anchors, usually 3, are inserted into the margin of the glenoid. These embedded ‘anchors’ grip the bone and allow the labrum to be tightened against the glenoid via sutures passed through both the labrum and the anchor. In this way the Bankart lesion is repaired, allowing the tissues to heal in this position.

Possible Associated Procedures

-Examination under anaesthesia
-Arthroscopic assessment of the lesion
-Inferior capsular shift ( link)
-SLAP repair
Rotator Interval Repair

Main Possible Complications

-Infection
-Nerve damage
-Blood vessel damage
-Recurrence of anterior instability
Shoulder stiffness

After the operation

  • The arm will be rested in a controlled position in a sling or brace. The Physiotherapist and nursing staff will show you how to adjust and safely remove and apply this. (Link to living with a sling –ULTRASLING II ER and picture)
  • You will not require an x ray
  • You will usually be able to return home the same day or following day
  • You can expect to use painkillers for two after surgery, three times a day and from then, over the following 4 weeks, an hour before a physiotherapy or more intense exercise session.
  • You will be shown specific shoulder and arm exercises by your physiotherapist before you leave the hospital. These exercises are very important and must be carried out accurately after leaving the hospital on a daily basis at home; ideally 3 times a day. It is very important that you DO NOT EXTERNALLY ROTATE the shoulder during the first four weeks after surgery. Make sure that you are shown this by the physiotherapist before leaving the hospital .
  • The stitches must be removed or the wound inspected (if absorbable sutures are used) at 14 days after surgery; either with your GP’s practice nurse or at the hospital.

 

BANKART REPAIR ARTHROSCOPIC

Purpose

To repair the detatched antero-inferior labrum( Bankart Lesion ) to the glenoid with minimum loss of external rotation.

Indications

The procedure is appropriate for patients with a torn labrum, diagnosed by arthroscopic evaluation or MRI scan. Repair is indicated especially after recurrent dislocation but should be considered after the first dislocation in higher demand sports men and women.
Skin Incisions

Three incision portals are used: anterior ,anterior-superior and posterior.
DIAG HERE

 

Procedure

During the operation a full diagnostic evaluation of the glenohumeral joint is made. The labrum, the degree of damage to the head of the humerus ( Hill Sachs Lesion), the degree of laxity in the glenohumeral capsule and ligaments are all assessed. Concurrent pathology is excluded.
The procedure holds the labrum in the repaired position, allowing the tissues to heal.

Possible Associated Procedures

-Arthroscopic assessment of the gleno humeral joint
-Arthroscopic capsular shift
-SLAP repair

Main Possible Complications

-Infection
-Nerve and blood vessel damage
-Recurrence of anterior instability
-Shoulder stiffness

After your operation

  • The arm will be rested in a supported position in a sling or brace. The physiotherapist or nursing staff will show you how to adjust and safely remove and reapply this (link to living with a sling ULTRASLING II ER )
  • You will not need an x ray
  • You will either go home the same day or the day after
  • You can expect to need painkillers for one or two weeks after surgery to control the background pain and from then an hour before a physiotherapy or heavier exercise session.
  • You will be shown specific shoulder and arm exercises by your physiotherapist before you leave the hospital. These exercises are very important and must be carried out accurately after leaving the hospital on a daily basis at home;ideally 3 times a day.It is very important that you DO NOT EXTERNALLY ROTATE THE SHOULDER during the first four weeks after surgery. Make sure that you are shown this by your physiotherapist before leaving the hospital.
  • The stitches must be removed, or the wound inspected( if absorbable sutures are used) at 14 days after surgery; either with your GPs practice nurse or at the hospital.