Bankhart Repair Protocols

A Bankart lesion occurs when a ligament and the labrum of the shoulder -- a thick piece of cartilage that forms around the shoulder joint to improve stability -- become injured due to a shoulder dislocation. Such dislocations typically involve a fall backwards with the arm outstretched behind the body.

Surgical Methods

• Among two surgical methods for repairing a Bankart lesion, the open surgical approach involves suturing and tightening the capsule that surrounds the shoulder joint. This method, however, requires extra precautions, as the subscapularis muscle -- which plays a key role in muscular control of the shoulder -- is involved, and damage during surgery could cause decreased range of motion. Most surgeons use arthroscopic surgery, which involves anchoring the capsule to surround the shoulder joint without tightening it. While this results in a weaker repair and a slightly increased risk of future instability, less damage occurs during the operation.

Arthroscopic Protocol

• To allow healing while minimizing the loss of range of motion, the patient must wear a sling almost constantly during the first four weeks after surgery. The doctor will limit extension, reaching the arm behind the body and turning the arm outward, and allow no overhead movement during that time. Movement during this time should only be passive, except under a physical therapist's supervision.

  At the end of the fourth week, external rotation should reach 15 degrees and flexion to 90 degrees. After four weeks, the patient typically spends the majority of her waking hours without the sling, but should use the sling when in high-traffic areas, such as the grocery store and ball games. A full range of motion ideally occurs by week 10.

Open Surgical Protocol

• Gentle, passive motion to tolerance is needed immediately after an open surgical repair, with no muscle activation to move the shoulder. Patients having this surgery should also avoid reaching back, turning the arm away from the body and turning the arm to the body against resistance for the first four weeks. Passive range of motion of external and internal rotation, allowing the arm to turn toward and away from the body, is allowed by the end of four weeks. Tolerance of the patient determines his overhead movement, but he may experience some discomfort and pain when turning the arm away from the body. Full range of motion typically occurs by week nine.

Strengthening Protocol

• Strengthening exercises should begin with isometrics, allowing muscle contraction while preventing arm movement. After four weeks, the patient can add internal and external rotation exercises with a resistance band. By the sixth week, resistance exercises should be added to improve strength. Throwing athletes may begin a throwing progression 16 to 18 weeks after surgery if cleared by the therapist and physician with no compensation or discomfort. Patients usually resume overhead sports by nine months after surgery -- some return even earlier, depending upon recovery rate.