Arthroscopic Bankart Repair Physiotherapy
Protocol
A Bankart repair is carried out for patients with traumatic anterior recurrent
dislocation of the shoulder. Almost invariably the patient will have undergone
an investigation such as an MRI arthrogram or rarely, a diagnostic
arthroscopy prior to their Bankart repair to accurately define the cause of their
instability and to ensure no damage has occurred to other structures in the
shoulder. All patients will have detachment of the anterior glenoid labrum (a
Bankart lesion) and all of them will have a dent on the back of the humeral
head (the Hill Sachs lesion) caused by the posterior aspect of the humeral
head striking the front of the glenoid at the moment of dislocation. Many
patients will have dislocated so many times that they will have stretched the
anterior and the inferior parts of the shoulder capsule creating additional laxity.
The primary aim of surgery is to secure the glenoid labrum back in to place
and restore normal tension back to the capsule and the ligament.
The goals of post operative rehabilitation are to restore shoulder movement
and to restore the balancing and controlling functions of the muscles around
the scapula and the glenohumeral joint. In the later stages of rehabilitation
strength and stability during the functional activities that the patient requires
become important and this stage of the programme needs to be individualised
for the patients particular working and sporting demands.
Restrictions are placed on the range of movement during the first six weeks
as the labral repair is held together by a very small number of stitches and
healing of the labrum to the glenoid needs to occur before undue stresses are
placed on it. This means restrictions are placed on the range of external
rotation for the first six weeks and the patient is advised to use their sling
when they are not carrying out their exercises and in bed at night.
Authors Mr S J Gregg-Smith Consultant Orthopaedic and trauma
surgeon and Mr G Jennings Consultant Orthopaedic and trauma
surgeon
Produced Feb 2010
Post-Op Physiotherapy for Arthroscopic Bankart Repairs
NB this protocol only applies to patients who have undergone arthroscopic
Bankart repairs. Please see the relevant protocol for patients who have
undergone open procedures.
Phase 1 (Immediately Post-Op to 2 weeks)


The shoulder is rested in a sling for approximately for 4 weeks
following surgery to allow the labrum and ligaments to heal.
Exercises:
1. Postural advice especially sleeping position
2. Passive shoulder flexion (with arm in internal rotation) no more
than 90º
3. Passive external rotation to neutral
4. Shoulder girdle range of movement and setting exercises
5. Postural correction out of the sling
6. Neck, hand and elbow exercises to maintain range of movement
7. Scar massage when stitches out
Aims at 2 weeks:
 Passive shoulder flexion to 90º
 Passive shoulder external rotation to neutral
 Decrease pain and swelling with use of painkillers/anti-inflammatories
NB: avoid combined abduction and external rotation for 6 weeks
Phase 2 (weeks 3-4)

Exercises:
1. Isometric flexion, abduction, external and internal rotation, as
pain allows.
2. Active-assisted shoulder flexion (with arm in neutral or internal
rotation) to no more than 130º
3. Active-assisted external rotation to 20º.
8. Shoulder girdle range of movement and setting exercises
4. Serratus anterior isometric
5. Scar massage when stitches removed
Aims at 4 weeks:
 Wean off sling during day
 Active-assisted shoulder flexion more than 130º
 Active-assisted shoulder external rotation to 20º
NB: avoid combined abduction and external rotation for 6 weeks
Authors Mr S J Gregg-Smith Consultant Orthopaedic and trauma
surgeon and Mr G Jennings Consultant Orthopaedic and trauma
surgeon
Produced Feb 2010
Phase 3 (weeks 5-12)

Exercises:
1. Active shoulder flexion (with arm in neutral or internal rotation
until six weeks)
2. Active shoulder external rotation (working to full range after six
weeks)
3. Active assisted shoulder abduction (in internal rotation until six
weeks)
4. Hand behind back exercises
5. Unrestricted active range of movement after six weeks
6. Hydrotherapy if patient not progressing
7. Core stability exercises e.g. superman
8. Dynamic trunk stability
Aims at 12 weeks:
 Wean off sling if not done so already
 Full range of movement
 Good scapulothoracic control
Authors Mr S J Gregg-Smith Consultant Orthopaedic and trauma
surgeon and Mr G Jennings Consultant Orthopaedic and trauma
surgeon
Produced Feb 2010