Bankart Repair

What is a Bankart Repair?

Your shoulder is the most mobile joint in your body. It is dependant on muscles, ligaments (including the joint 'capsule') and a rim of cartilage (called the 'labrum') to stabilise it during movement.

Some injuries to the shoulder can dislocate it forwards, stretching and in some cases, tearing the joint capsule and ligaments away from the front of the joint. A tear of the anterior-inferior labrum is called a 'Bankart Lesion'.

The operation involves tightening and/or repairing the overstretched and damaged ligaments, capsule and cartilage. The surgeon will reattach a torn labrum back to the shoulder socket using special anchors.

What are the benefits of having a Bankart Repair?

The purpose of a Bankart repair operation is to re-attach the capsule and ligaments to the socket of the shoulder joint to restore stability to your shoulder and prevent further dislocations.

What are the risks of having a Bankart Repair?

All operations involve an element of risk, these are very small but you need to be aware of them and can discuss them with your doctor at any time. The risks are:

Complications relating to the anaesthetic
Infection
Stiffness and or pain around the shoulder
Damage to nerves or blood vessels around the shoulder
Need to re-do the surgery e.g. if the repair fails and the shoulder becomes unstable again -this occurs in only 2-10% of cases.

What sort of anaesthetic will be given to me?

You will usually be given a general anaesthetic. General anaesthesia is drug-induced unconsciousness: it is always provided by an anaesthetist, who is a doctor with specialist training.

Unfortunately, general anaesthesia can cause side effects and complications. Side effects are common, but are usually short-lived: they include nausea, confusion and pain. Complications are very rare, but can cause lasting injury: they include awareness, paralysis and death.

The risks of anaesthesia and surgery are lower for those who are undergoing minor surgery, and who are young, fit, active and well.

You will be given an opportunity to discuss anaesthetic options and risks with your anaesthetist before your surgery.

If you are worried about any of these risks, please speak to your Consultant or a member of his team.

Getting ready for your operation

You will usually be seen in the pre-operative clinic before you are admitted to hospital. Here you will have blood tests, a chest x-ray, and sometimes a heart trace, if required, as part of your anaesthetic assessment.

The nurse will ask routine questions about your health, the medicine you take at the moment and any allergies you may have. You will be given instructions on eating and drinking.

Prior to your surgery, you will be asked to sign a consent form to confirm that you understand the procedure, and what the operation involves. You will be able to further discuss the operation with Mr Brownson at this time.

The day of your operation

You will come into hospital on the day of your operation.

Please leave body piercings at home. Acrylic nails and nail polish will also need to be removed.

If you are on regular medication, you will be told to take this if necessary.

You will be asked to take a shower and put on a gown and disposable underwear.

A bracelet with your personal details will be attached to your wrist.

You may be prescribed some medication to take before your operation by the anaesthetist. A member of the nursing staff will give this to you.

A nurse and porters will take you to the operating theatre.

Your dentures, glasses or hearing aid can stay with you on your journey to the operating theatre.

When you arrive in the waiting area, a theatre nurse will check your details with you. You will then be asked to put on a disposable hat. The ward nurse will then leave you and you will then be taken to the anaesthetic room.

What should I expect after my operation?

After your operation you will be kept in the theatre recovery room before being transferred to the ward.

A nurse will check your pulse, blood pressure, and breathing rate regularly. It is important that if you feel any pain you must tell the nursing staff, who can give you painkillers to help.

The nursing staff will also advise you when you can start taking sips of water. Anaesthetics can make some people sick. If you feel sick we advise you not to drink until this feeling has passed. The nursing staff may offer an injection to help this sick feeling go away.

The ward physiotherapist will see you before you are discharged home to:
- Assess your shoulder
- Show you use of the sling and advise on when to wear it
- Teach you the exercises you need to do immediately
- Arrange an out-patient physiotherapy appointment at your local hospital

Going Home

Your doctor will normally discharge you on the day of your surgery or the morning after if your pain is well controlled.

Your exercises will be supervised by outpatient physiotherapy appointments, which will be arranged for you before you leave hospital.

Discharge Information

Pain relief & medication

The nursing staff will advise you about painkillers before you leave the hospital. Please tell the nurses what painkilling tablets you have at home.

Your wound

Your wounds must remain covered with dressings until your outpatient appointment, where your sutures will be removed.

Getting back to normal

Remember that you have just had an operation. It is normal to feel more tired than usual for a few days after having an operation.

Your shoulder is likely to be uncomfortable in the first few days post-surgery. This is normal but can be helped by;

Using ice on your shoulder for 15 minutes, 2 times per day or after exercise and therapy. Gel packs, frozen peas or a plastic pack of ice can be used. These must be wrapped in a moist towel as direct contact with the skin can cause burns (cover your dressings with cling film or a plastic bag to prevent them getting wet).
Sleeping can be uncomfortable if you try and lie on your operated arm. We would recommend that initially you lie on your back or on the opposite side. If you lie on your back support the operated arm with a folded pillow under your lower arm. Make sure that your elbow is above your shoulder. If you are on your side then a folded pillow supports your operated arm from your elbow to your wrist.

Your sling is for comfort only and should be discarded as soon as possible -usually within the first 2-4 days. You may find it useful to continue to wear the sling at night for a little longer if the shoulder feels uncomfortable. In the first few days post-op it is generally recommended to wear the sling if you are going out to protect your arm.
Posture can make a significant difference to your pain post surgery. Avoid 'hitching' your shoulder or holding it in an elevated position. Also try to avoid slumping or standing/sitting with round shoulders.

In the first few days after surgery you will find it helps to support your arm on pillows with your elbow in front of your shoulder and slightly out to the side when you are sitting down (see picture).

Returning to work

You can self-certify for the first seven days of sickness. Before you are discharged, a medical certificate (sick note) may be issued by your hospital doctor to cover the expected time off you will need. The time that you can return to work will depend on the nature of your work. If you are in a relatively sedentary job you may be able to return as early as 1-2 weeks after surgery. If your job involves heavy lifting or sustained overhead positions it may take up to 6-8 weeks before you can return. Your doctor and physiotherapist will discuss this with you and advise you accordingly.

Leisure activities

You should avoid sustained repetitive overhead activities for up to 12 weeks. You can usually start swimming when your sutures are removed- breast-stroke is advisable initially. Patients generally return to activities such as Golf at about 6 weeks. For specific guidance regarding sport or DIY please speak to your physiotherapist.

Driving - When you should feel comfortable and have a good range of movement you can begin driving, typically at approximately the 4 weeks post operative stage, after your sling has been removed. It is advisable to check this with your Doctor or Physiotherapist if you are unsure. It is important to advise your Insurance Company that you have had Shoulder Surgery.

Further Appointments

You will be seen in outpatient's clinic approximately 1-2 weeks after your surgery. This appointment will be made and given to you before you are discharged from hospital.

Physiotherapy Appointments

It is important that physiotherapy is commenced at the appropriate time after surgery. For some patients this will mean an appointment within one or two days if it is felt that there is a risk of your shoulder stiffening up. However, for the majority of patients an appointment will be arranged within the first week after surgery.

By the time of discharge from hospital all patients should either already have a physiotherapy appointment (which may have already been sent to you before your admission into hospital) or should have an appointment made during or shortly after the hospital stay. You will be aware of this process as the physiotherapy staff will collect details from you including your preference of hospital for your physiotherapy.

The amount of physiotherapy you require will depend on your individual progress.