Sports Injuries Treatment

Sprains and strains are injuries affecting the muscles and ligaments. A sprain is an injury or tear of one or more ligaments that commonly occurs at the wrists, knees, ankles and thumbs. A strain is an injury or tear to the muscle. Strains occur commonly in the back and legs. Sprains and strains occur due to overstretching of the joints during sports activities and accidents such as falls or collisions.

Symptoms of sprains include pain, swelling, tenderness, bruising and joint stiffness. Symptoms of strains include muscle spasm and weakness, pain in the affected area, swelling, redness and bruising.

Immediately following an injury and before being evaluated by a medical doctor, you should initiate the P.R.I.C.E. method of treatment.

• Protection: Protect the injured area with the help of a support.
• Rest:Give rest to the affected area as more damage could result from putting pressure on the injury.
• Ice:Ice should be applied over a towel to the affected area for 15-20 minutes every two to three hours during the day. Never place ice directly over the skin.
• Compression: Wrapping the knee with an elastic bandage or an elasticated tubular bandage can help to minimize the swelling and support to the injured area.
• Elevation: Elevating the injured area above heart level will also help with swelling and pain.

Diagnosis involves a thorough physical examination. Your doctor will inspect the area of injury and joint mobility. X-rays or other tests may be ordered to rule out fractures or other pathology.

Your doctor may prescribe nonsteroidal anti-inflammatory drugs to reduce pain and inflammation. Physical therapy may be recommended for severe injuries. Surgery is rarely needed.

The shoulder is a highly mobile ball and socket joint. The ball of the upper arm bone (humerus) is held in place at the socket (glenoid) of the shoulder blade (scapula) by a group of ligaments. A partial dislocation of the shoulder joint is termed as a subluxation. This means the ball has partially moved out of the glenoid as opposed to a dislocation, where the ball completely moves out of the glenoid. Subluxation usually occurs from falls or a direct blow to your shoulder. It can also be caused due to a previous shoulder injury or if the ligaments in your shoulder are loose. Subluxations tend to reoccur due to laxity in the ligaments.

Subluxation of the shoulder includes the following symptoms:

• A feeling that your shoulder has moved out of place
• Pain, numbness or weakness of the injured shoulder
• A feeling of looseness of the shoulder

Subluxation of the shoulder is diagnosed by checking your medical history and symptoms and performing a physical examination of your shoulder. Your doctor may also recommend X-rays to confirm diagnosis and check for any fractures of the shoulder joint.

Subluxation of the shoulder is treated with rest, ice packs and NSAID’s to reduce the pain and inflammation. You may be referred to physical therapy for shoulder strengthening exercises to help prevent recurrence. Surgery may be required to repair the ligaments if conservative treatment measures do not prevent further subluxations.

Patella (knee cap) is a protective bone attached to the quadriceps muscles of the thigh by quadriceps tendon. Patella attaches with the femur bone and forms a patellofemoral joint. Patella is protected by a ligament which secures the kneecap from gliding out and is called as medial patellofemoral ligament (MPFL).

Dislocation of the patella occurs when the patella moves out of the patellofemoral groove, (called as trochlea) onto a bony head of the femur. If the knee cap partially comes out of the groove, it is called as subluxation and if the kneecap completely comes out, it is called as dislocation (luxation). Patella dislocation is commonly observed in young athletes between 15 and 20 years and commonly affects women because of the wider pelvis creates lateral pull on the patella.

Some of the causes for patellar dislocation include direct blow or trauma, twisting of the knee while changing the direction, muscle contraction, and congenital defects. It also occurs when the MPFL is torn. The common symptoms include pain, tenderness, swelling around the knee joint, restricted movement of the knee, numbness below the knee, and discoloration of the area where the injury has occurred.

Your doctor will examine your knee and suggests diagnostic tests such as X-ray, CT scan, and MRI scan to confirm condition and provide treatment. There are non-surgical and surgical ways of treating patellofemoral dislocation.

Acromioclavicular joint (AC joint) dislocation or shoulder separation is one of the most common injuries of the upper arm. It commonly occurs in athletic young patients and results from a fall directly onto the point of the shoulder. It involves separation of the AC joint and injury to the ligaments that support the joint. The AC joint forms where the clavicle (collarbone) meets the shoulder blade (acromion).

A mild shoulder separation is said to have occurred when there is AC ligament sprain that does not displace the collarbone. In more serious injury, the AC ligament tears and the coracoclavicular (CC) ligament sprains or tears slightly causing misalignment in the collarbone. In the most severe shoulder separation injury, both the AC and CC ligaments get torn and the AC joint is completely out of its position.

Anatomic Reconstruction

Of late, research has been focused on improving surgical techniques used to reconstruct the severely separated AC joint. The novel reconstruction technique that has been designed to reconstruct the AC joint in an anatomic manner is known as anatomic reconstruction. Anatomic reconstruction of the AC joint ensures static and safe fixation and stable joint functions. Nevertheless, a functional reconstruction is attempted through reconstruction of the ligaments. This technique is done through an arthroscopically assisted procedure. A small open incision will be made to place the graft.

This surgery involves replacement of the torn CC ligaments by utilizing allograft tissue. The graft tissue is placed at the precise location where the ligaments have torn and fixed using bio-compatible screws. The new ligaments gradually heal and help restore the normal anatomy of the shoulder.

Postoperative rehabilitation includes use of shoulder sling for 6 weeks followed by which physical therapy exercises should be done for 3 months. This helps restore movements and improve strength. You may return to sports only after 5-6 months after surgery.

Golfer’s elbow, also called Medial Epicondylitis, is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and microtears in the tendons that attach to the medial epicondyle. The medial epicondyle is the bony prominence that is felt on the inside of the elbow.

Golfer’s elbow and Tennis Elbow are similar except that Golfer’s elbow occurs on the inside of the elbow and Tennis Elbow occurs on the outside of the elbow. Both conditions are a type of Tendonitis which literally means “inflammation of the tendons”.

Signs and Symptoms

Signs and symptoms of Golfer’s Elbow can include the following:

• Elbow pain that appears suddenly or gradually
• Achy pain to the inner side of the elbow during activity
• Elbow stiffness with decreased range of motion
• Pain may radiate to the inner forearm, hand or wrist
• Weakened grip
• Pain worsens with gripping objects
• Pain is exacerbated in the elbow when the wrist is flexed or bent forward toward the forearm

Causes

Golfer’s Elbow is usually caused by overuse of the forearm muscles and tendons that control wrist and finger movement but may also be caused by direct trauma such as with a fall, car accident, or work injury.

Golfer’s elbow is commonly seen in golfer’s, hence the name, especially when poor technique or unsuitable equipment is used when hitting the ball. Other common causes include any activity that requires repetitive motion of the forearm such as: painting, hammering, typing, raking, pitching sports, gardening, shoveling, fencing, and playing golf.

Diagnosis

Golfer’s Elbow should be evaluated by an orthopedic specialist for proper diagnosis and treatment.

• Medical History
• Physical Examination
• Your physician may order an x-ray to rule out a fracture or arthritis as the cause of your pain.
• Occasionally, if the diagnosis is unclear, your physician may order further tests to confirm golfer’s elbow such as MRI, ultrasonography, and injection test

Conservative Treatment Options

Your physician will recommend conservative treatment options to treat the symptoms associated with Golfer’s Elbow. These may include the following:

• Activity Restrictions: Limit use and rest the arm from activities that worsen symptoms
• Orthotics: Splints or braces may be ordered to decrease stress on the injured tissues
• Ice: Ice packs applied to the injury will help diminish swelling and pain. Ice should be applied over a towel to the affected area for 20 minutes four times a day for a couple days. Never place ice directly over the skin
• Medications: Anti-inflammatory medications and/or steroid injections may be ordered to treat the pain and swelling
• Occupational Therapy: OT may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased
• Pulsed Ultrasound: A non-invasive treatment used by therapists to break up scar tissue and increase blood flow to the injured tendons to promote healing
• Professional instruction: Consulting with a sports professional to assess and instruct in proper swing technique and appropriate equipment may be recommended to prevent recurrence

Surgery

If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend surgery to treat Golfers Elbow. The goal of surgery to treat Golfers Elbow is to remove the diseased tissue around the inner elbow, improve blood supply to the area to promote healing, and alleviate the patient’s symptoms.

Tennis elbow is the common name used for the elbow condition called lateral epicondylitis. It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow (lateral epicondyle). It is a painful condition occurring from repeated muscle contractions at the forearm that leads to inflammation and micro tears in the tendons that attach to the lateral epicondyle. The condition is more common in sports activities such as tennis, painting, hammering, typing, gardening and playing musical instruments. Patients with tennis elbow experience elbow pain or burning that gradually worsens and a weakened grip

Your doctor will evaluate tennis elbow by reviewing your medical history, performing a thorough physical examination and ordering X-rays, MRI or electromyogram (EMG) to detect any nerve compression.

Your doctor will first recommend conservative treatment options to treat the tennis elbow symptoms. These may include:

• Limit use and rest the arm from activities that worsen symptoms.
• Splints or braces may be ordered to decrease stress on the injured tissues.
• Apply ice packs on the elbow to reduce swelling.
• Avoid activities that bring on the symptoms and increase stress on the tendons.
• Anti-inflammatory medications and/or steroid injections may be ordered to treat pain and swelling.
• Physical therapy may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased.
• Pulsed ultrasound may be utilized to increase blood flow and promote healing to the injured tendons.

If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend a surgical procedure to treat tennis elbow called lateral epicondyle release surgery. Your surgeon will decide whether to perform your surgery in the traditional open manner (single large incision) or endoscopically (2 to 3 tiny incisions and the use of an endoscope –narrow lighted tube with a camera). Your surgeon will decide which options are best for you depending on your specific circumstances.

Your surgeon moves aside soft tissue to view the extensor tendon and its attachment on the lateral epicondyle. The surgeon then trims the tendon or releases the tendon and then reattaches it to the bone. Any scar tissue present will be removed as well as any bone spurs. After the surgery is completed, the incision(s) are closed by suturing or by tape.

Following surgery, you are referred to physical therapy to improve the range of motion and strength of your joint.

The knee is one of the most complex and largest joint in the body, and is more susceptible to injury. Meniscal tears are one among the common injuries to the knee joint. It can occur at any age, but are more common in athletes playing contact sports.

The meniscus is a small, “c” shaped piece of cartilage in the knee. Each knee consists of two menisci, medial meniscus on the inner aspect of the knee and the lateral meniscus on the outer aspect of the knee. The medial and lateral meniscus act as cushion between the thigh bone (femur) and shin bone (tibia). The meniscus has no direct blood supply and for that reason, when there is an injury to the meniscus, healing cannot take place. The meniscus acts like a “shock absorber” in the knee joint.

Meniscal tears often occur during sports. These tears are usually caused by twisting motion or over flexing of the knee joint. Athletes who play sports such as football, tennis and basketball are at a higher risk of developing meniscal tears. They often occur along with injuries to the anterior cruciate ligament, a ligament that crosses from the femur (thigh bone) to the tibia (shin bone).

Various types of meniscal tears that can occur are longitudinal, bucket handle, flap, parrot -beak and mixed or complex.

The patella (knee cap) is a small bone that shields your knee joint. It is found in front of your knee, in a groove called the trochlear groove that sits at the junction of the femur (thighbone) and tibia (shinbone). Articular cartilage present below the patella and end of the femur cushion and help the bones glide smoothly over each other when the legs move. This joint is stabilized and supported by a network of soft tissues. The medial patellofemoral ligament (MPFL) connects to the inner side of the patella and helps to keep it from slipping away from the knee. Damage to this ligament leads to patellar dislocation.

Patellar dislocation occurs when the knee cap slides out of the trochlea. When dislocation of the patella occurs on more than one occasion, it is referred to as recurrent patellar dislocation. The risk of further dislocation increases to almost 70% to 80% after two episodes of dislocation.

Runner’s knee, also called patellofemoral pain syndrome refers to pain under and around your kneecap. Runner’s knee includes a number of medical conditions such as anterior knee pain syndrome, patellofemoral malalignment, and chondromalacia patella that cause pain around the front of the knee. As the name suggests, runner’s knee is a common complaint among runners, jumpers, and other athletes such as skiers, cyclists, and soccer players.

Causes

Runner’s knee can result from poor alignment of the kneecap, complete or partial dislocation, overuse, tight or weak thigh muscles, flat feet, direct trauma to the knee. Patellofemoral pain often comes from strained tendons and irritation or softening of the cartilage that lines the underside of the kneecap. Pain in the knee may be referred from other parts of the body, such as the back or hip.

Symptoms

The most common symptom of runner’s knee is a dull aching pain underneath the kneecap while walking up or down stairs, squatting, kneeling down, and sitting with your knees bent for long period of time.

Anatomy

Pain usually occurs under or around the front of the kneecap (patella) where it attaches with the lower end of the thighbone (femur). The patella, also called kneecap, is a small flat triangular bone located at the front of the knee joint. The kneecap or patella is a sesamoid bone that is embedded in a tendon that connects the muscles of the thigh to the shin bone (tibia). The function of the patella is to protect the front part of the knee.

Diagnosis

To diagnose runner’s knee, your doctor will ask about your symptoms, medical history, any sports participation, and activities that aggravate your knee pain. Your doctor will perform a physical examination of your knee. Diagnostic imaging tests such as X-rays, MRIs, and CT scans, and blood tests may be ordered to check if your pain is due to damage to the structure of the knee or because of the tissues that attach to it.

Treatment

The first treatment step is to avoid activities such as running and jumping, that causes pain. Treatment options include both non-surgical and surgical methods. Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. Non-steroidal anti-inflammatory medications may be prescribed to reduce pain.

Exercises: Your doctor may recommend an exercise program to improve the flexibility and strength of thigh muscles. Cross-training exercises to stretch the lower extremities may also be recommended by your doctor.

Other non-surgical treatments include:

• Knee taping: An adhesive tape is applied over the patella, to alter the kneecap alignment and movement. Taping of the patella may reduce pain.
• Knee brace: A special brace for knee may be used during sports participation which may help reduce pain.
• Orthotics: Special shoe inserts may be prescribed for those with flat feet that may help relieve the pain.

In some cases, you may need surgery that includes arthroscopy and realignment. During arthroscopy, damaged fragments are removed from the kneecap, while realignment moves the kneecap back to its alignment, thus reducing the abnormal pressure on cartilage and supporting structures around the front of the knee.

Prevention

• If you are overweight, you may need to control your weight to avoid overstressing your knees
• Gradually increase the intensity of your workout
• If you have flat feet or other foot problems use shoe inserts
• Avoid running on hard surfaces
• Wear proper fitting good quality running shoes with good shock absorption
• Avoid running straight down hills; instead walk down it or run in a zigzag pattern
• Warm up for 5 minutes before starting any exercise. Also stretch after exercising

The rotator cuff consists of tendons and muscles that hold the bones of the shoulder joint together. Rotator cuff muscles allow you to move your arm up and down. Rotator cuff injuries often cause a decreased range of motion.

Tendons are the soft tissues connecting muscles to the bones. The achilles tendon is the longest tendon in the body and is present behind the ankle, joining the calf muscles with the heel bone. Contraction of the calf muscles tightens the achilles tendon and pulls the heel, enabling foot and toe movements necessary for walking, running and jumping.

The achilles tendon is often injured during sports resulting in an inflammatory condition called tendonitis which is characterized by swelling and pain. In some cases, severe injury results in a tear or rupture of the Achilles tendon requiring immediate medical attention.

Causes

The tear or rupture of the Achilles tendon is commonly seen in middle aged male who involve in sports activities occasionally or in weekend athletes. The tendon ruptures because of weakened tendons due to advanced age or from sudden bursts of activity during sports such as tennis, badminton, and basketball.

People with a history of tendonitis, those suffering from certain diseases such as arthritis and diabetes, or taking certain antibiotics are more susceptible for ruptures.

Symptoms

The classic symptom of an Achilles tendon rupture is the inability to rise up on your toes. Patients often describe a “popping” or “snapping” sound with severe pain, swelling and stiffness in the ankle region followed by bruising of the area. If the tendon is partially torn and not ruptured, pain and swelling may be mild.

Diagnosis

The diagnosis of a torn or ruptured Achilles tendon starts with a physical examination of the affected area, followed by a Thompson test in which the calf muscle is pressed with the patient lying on their stomach to check whether the tendon is still connected to the heel or not.

In certain cases, an ultrasound or MRI scan may be needed for a clear diagnosis.

Treatment

The main objective of treatment is to restore the normal physiology of the Achilles tendon so the patient can perform activities as before the injury.

Immediately following a torn or ruptured Achilles tendon you should employ the RICE method as follows:

• Rest of the injured part
• Ice packs application at the site of injury to prevent swelling
• Compress the injured area to prevent swelling
• Elevate the injured part to reduce swelling

Treatment of a torn or ruptured Achilles tendon includes non-surgical or surgical methods. Non-surgical methods involve casting the injured area for six weeks for the ruptured tendon to reattach itself and heal. After removal of the cast, physical therapy is recommended to prevent stiffness and restore lost muscle tone.

Surgery may be recommended especially for competitive athletes, those who perform physical work, or in instances where the tendon re-ruptures. Your surgeon will stitch the torn tendon back together with strong sutures and tie the sutures together. Your surgeon may reinforce the Achilles tendon with other tendons depending on the extent of the tear. If the tendon has avulsed or pulled off the heel bone, your surgeon will reattach the tendon to the heel bone.

Risks and Complications

Every medical treatment including surgeries is associated with certain risks and complications. Some of them include infection, bleeding, nerve injury, and blood clots.

The anterior cruciate ligament, or ACL, is one of the major ligaments of the knee that is in the middle of the knee and runs from the femur (thigh bone) to the tibia (shin bone). It prevents the tibia from sliding out in front of the femur. Together with posterior cruciate ligament (PCL) it provides rotational stability to the knee.

An ACL injury is a sports related injury that occur when the knee is forcefully twisted or hyperextended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.

When you injure your ACL, you might hear a “popping” sound and you may feel as though the knee has given out. Within the first two hours after injury, your knee will swell and you may have a buckling sensation in the knee during twisting movements.

Diagnosis of an ACL tear is made by knowing your symptoms, medical history, performing a physical examination of the knee, and performing other diagnostic tests such as X-rays, MRI scans, stress tests of the ligament, and arthroscopy.

Treatment options include both non-surgical and surgical methods. If the overall stability of the knee is intact, your doctor may recommend nonsurgical methods. Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. Physical therapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee.

Young athletes involved in pivoting sports will most likely require surgery to safely return to sports. The usual surgery for an ACL tear is an ACL reconstruction which tightens your knee and restores its stability. Surgery to reconstruct an ACL is done with an arthroscope using small incisions. Your doctor will replace the torn ligament with a tissue graft that can be obtained from your knee (patellar tendon) or hamstring muscle. Following ACL reconstruction, a rehabilitation program is started to help you to resume a wider range of activities.

Medial collateral ligament (MCL) is one of four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and is present on the inside of the knee joint. This ligament helps stabilize the knee. An injury to the MCL may occur as a result of direct impact to the knee. An MCL injury can result in a minor stretch (sprain) or a partial or complete tear of the ligament. The most common symptoms following an MCL injury include pain, swelling, and joint instability.

Diagnosis

An MCL injury can be diagnosed with a thorough physical examination of the knee and diagnostic imaging tests such as X-rays, arthroscopy, and MRI scans. X-rays may help rule out any fractures. In addition, your doctor will perform a valgus stress test to check for stability of the MCL. In this test, the knee is bent approximately 30° and pressure is applied on the outside surface of the knee. Excessive pain or laxity is indicative of medial collateral ligament injury.

Management

If the overall stability of the knee is intact, your doctor will recommend non-surgical methods including ice, physical therapy, and bracing.

Surgical reconstruction is rarely recommended for MCL tears but may be necessary in patients that fail to heal properly with residual knee instability. These cases are often associated with other ligament injuries. If surgery is required, a ligament repair may be performed, with or without reconstruction with a tendon graft; depending on the location and severity of the injury.

Indications and Contraindications

Medial collateral ligament reconstruction is indicated in patients with chronic MCL instability despite appropriate nonsurgical treatment.

Medial collateral ligament reconstruction is contraindicated in patients with degenerative changes in the medial or lateral compartment, active infection, ligament instability, or presence of chronic diseases that can hamper surgical management or compliance to postoperative rehabilitation instructions.

Procedure

The procedure is performed under general anesthesia. Arthroscopic examination of the knee may be performed to rule out any associated injuries including anterior cruciate ligament (ACL) and posterior cruciate ligament PCL) tears.

The surgical procedure for medial collateral ligament reconstruction involves the following steps:

• Your surgeon will make an incision over the medial femoral condyle.
• Care is taken to move muscles, tendons and nerves out of the way.
• The donor tendon is usually harvested from the Achilles tendon.
• The soft tissue around the femur is debrided to assist the insertion of the Achilles bone plug.
• For placing the graft, a tunnel is created from a guide pin to the anatomic insertion of the MCL on the tibia, using the index finger and surgical scissors.
• The Achilles tendon allograft is inserted in the femoral tunnel and fixed using screws.
• The MCL graft is made taut, with the knee at 20° flexion under varus stress, and fixed to the tibia with a screw and a spiked washer.
• The incision is closed with sutures and covered with sterile dressings.

Postoperative Care

In the first two weeks after the surgery, toe-touch and weight-bearing is allowed with the knee brace locked in full extension. After 2 weeks 0° to 30° of motion is allowed at the knee. At 4 weeks, knee flexion is allowed from 60° to 90° of motion and full weight bearing is permitted. At 6 weeks, the brace is removed, and you are allowed to perform full range of motion. Crutches are often required until you regain your normal strength.

Risks and Complications

Knee stiffness and residual instability are the most common complications associated with MCL reconstruction. The other possible complications include:

• Numbness
• Infection
• Blood clots (Deep vein thrombosis)
• Nerve and blood vessel damage
• Failure of the graft
• Loosening of the graft
• Decreased range of motion

The shoulder joint is a ball and socket joint. A ‘ball’ at the top of the upper arm bone (the humerus) fits neatly into a ‘socket’, called the glenoid, which is part of the shoulder blade (scapula). The term SLAP (superior – labrum anterior-posterior) lesion or SLAP tear refers to an injury of the superior labrum of the shoulder. The labrum is a ring of fibrous cartilage surrounding the glenoid for stabilization of the shoulder joint. The biceps tendon attaches inside the shoulder joint at the superior labrum of the shoulder joint. The biceps tendon is a long cord-like structure which attaches the biceps muscle to the shoulder and helps to stabilize the joint.

Causes

The most common causes include falling on an outstretched arm, repetitive overhead actions such as throwing, and lifting a heavy object. Overhead and contact sports may put you at a greater risk of developing SLAP tears.

Symptoms

The most common symptom is pain at the top of the shoulder joint. In addition, catching sensation and pain most often with activities such as throwing may also occur.

Diagnosis

Diagnosis is made based on the symptoms and physical examination. A regular MRI scan may not show up a SLAP tear and therefore an MRI with a contrast dye injected into the shoulder, is ordered. The contrast dye helps to highlight SLAP tears.

Treatment

Your doctor may recommend anti- inflammatory medications to control pain. In athletes who want to continue their sports, arthroscopic surgery of the shoulder may be recommended. Depending on the severity of the lesion, SLAP tears may simply require debridement or some may need to be repaired. A SLAP repair can be done using arthroscopic techniques that require only two or three small incisions.

Regular exercises that make the shoulder muscles strong should be done. Adequate warm-up exercises before activities and avoiding high contact sports can help prevent injuries that cause instability.

The shoulder joint (glenohumeral joint) is a ball and socket joint, where the head of the upper arm bone (humerus) attaches to the shoulder socket (glenoid cavity). The shoulder socket is extremely shallow and therefore needs additional support to keep the shoulder bones from dislocating. The labrum, a cuff of cartilage that encircles the shoulder socket, helps serve this purpose by forming a cup for the humeral head to move within. It provides stability to the joint, enabling a wide range of movements.

The labrum can sometimes tear during a shoulder injury. A specific type of labral tear that occurs when the shoulder dislocates is called a Bankart tear. This is a tear to a part of the labrum called the inferior glenohumeral ligament and is common in younger patients who sustain a dislocation of the shoulder. A Bankart tear makes the shoulder prone to repeat dislocation in patients under 30 years of age.

Diagnosis

Your physician will ask about your medical history and perform a thorough physical examination of your shoulder. Your doctor may recommend additional studies such as X-ray’s or an MRI.

Treatment

Conservative treatment measures for a Bankart tear include rest and immobilization with a sling followed by physical therapy.

Bankart repair surgery is indicated when conservative treatment measures do not improve the condition and repeated shoulder joint dislocations occur.

Description of Procedure

Bankart surgery can be performed by a minimally invasive surgical technique called arthroscopy.

During an arthroscopic Bankart procedure, your surgeon makes a few small incisions over your shoulder joint. An arthroscope, a slender tubular device attached with a light and a small video camera at the end is inserted through one of the incisions into your shoulder joint. The video camera transmits the image of the inside of your shoulder joint onto a television monitor for your surgeon to view. Your surgeon then uses small surgical instruments through the other tiny incisions to trim the edges of your glenoid cavity. Suture anchors are then inserted to reattach the detached labrum to the glenoid. The tiny incisions are then closed and covered with a bandage.

Arthroscopy causes minimal disruption to the other shoulder structures and does not require your surgeon to detach and reattach the overlying shoulder muscle (subscapularis) as with the open technique.

Post-operative Care

• After your surgery, you will spend about an hour in the recovery room.
• Your physical therapist will start you on shoulder exercises the day following your surgery to strengthen and improve the range of motion of your shoulder joint.
• You will be allowed to perform your daily activities as tolerated, but without lifting objects heavier than a plate or glass while you heal.
• Your arm may be placed in a sling for three weeks to restrict use of your operated shoulder.
• You may resume light low-risk activities, like jogging and swimming 8 to 10 weeks after surgery, and may be advised to avoid contact sports for some time.

Risks

Arthroscopic Bankart repair is a relatively safe procedure. Being minimally invasive it is associated with fewer risks and a quicker recovery. Some of the potential risks associated include:

• Infection
• Injury to adjacent nerves or blood vessels
• Stiffness of the joint
• Pain