Prolotherapy: The Best Alternative to Open Bankart Surgery
(for Labral tear of the shoulder)
Ross Hauser, M.D.

We get emails from all over the world. We recently received one that said, "...A relative dislocated his shoulder in June 2006 and started getting Prolotherapy injections in July 2006 and continued for about 12 months. He was able to participate in his track and field events at college, except for pole vaulting. Anytime he reached overhead and in back of his shoulder his shoulder would dislocate. He finally had an arthrogram done that showed a tear in the labrum and our Prolotherapist gave us the name of a surgeon who performed an open bankart surgery on him. He has begun physical therapy slowly already.

My question is this. I still believe in the merit of Prolotherapy. Can he benefit at all with his shoulder recovery by having injections at some point? I am not asking our Prolotherapist, because I am concerned at his lack of interest in pursuing reasons his shoulder was still dislocating after 12 visits. Will the previous prolo he received be of any benefit to him now? He is hoping to return to his sport in 6 months.”

Wow, this is a great, but extremely sad email. My initial thoughts were “did this person really need to get an open Bankart surgery?” In other words, did this person get Prolotherapy by an experienced Prolotherapist and did the Prolotherapist use every tool at his/her disposal to get the person better? Here are some thoughts I have if I was reviewing the case:

• This person is an elite athlete (I consider all college athletes elite athletes). As such, were strong solutions utilized from at the beginning of the treatment regime?

• Elite athletes depend on speed for healing. Was this person treated every two weeks or so? (He supposedly received 12 treatments over 10 months, which is too slowly for elite athletes, in my opinion, and not enough healing per visit compared to the demands an elite athlete puts on them.)

• Were even stronger solutions utilized once it was realized overhead activities were not possible?

• Was platelet rich plasma solution used for the Prolotherapy?

• Was healing optimized by eating according to Hauser Diet Typing?

• Was healing augmented by nutritional supplements?

• Was the athlete given guidance in his exercise program? (IE was the Prolotherapist an athlete who understood exercise physiology?)

Let me stop here because this last thought is extremely important. In other words, exercise helps healing, but if you put too much stress on a joint that is getting Prolotherapy, you will have too much degradation in relationship to repair during Prolotherapy to make positive gains.

In regard to this concerned relative’s other questions, Prolotherapy is a great tool to enhance healing after surgery. It is a good idea to help speed the healing after surgery. Remember what they said. This athlete may be back to his sport in six months. Unbelievable! Six months, are you kidding me?! I suspect if this patient would have come to Caring Medical he would be pole vaulting to his heart’s delight right now.

Let’s look at this situation. The patient started Prolotherapy in June 2006 and it is now June 2007. He may be back to athletics in January 2008. If he came to Caring Medical in June 2006, I believe there would have been a good chance that he would have been back to all sports including pole vaulting by September 2006. Perhaps he would have had to travel a bit to come to Chicago to get to our clinic for treatment, but in the end, he would have had a lot, lot, lot, less expense. Now he has had his shoulder sliced open.

How can you be so sure, Dr. Hauser, that you would have kept him from getting the surgery?
Well, we have a lot of experience with pole vaulters. We have treated the #2 ranked American woman pole vaulter and got her back to the national and world championships. We also treated the #1 male pole vaulter from Korea. Plus, I have had a lot of experience with labral/ligament tears of the shoulder in a wide array of athletes and active people.

So you have read this whole article thus far and don’t have a clue what a Bankart lesion or open Bankart surgery is, right? A Bankart lesion is a specific injury to a part of the shoulder joint called the labrum. Because the shoulder joint has a shallow socket, there is a cuff of cartilage/soft tissue called the labrum to hold the shoulder in place. When the labrum of the shoulder is torn, the shoulder has stability problems. A specific labral tear is called a Bankart lesion. When a shoulder joint dislocates, it often tears the bottom of the labrum called the inferior glenohumeral ligament. When the inferior glenohumeral ligament is torn, this is a called a Bankart lesion.

When a person has a Bankart lesion, he/she often experience repeated dislocations. Sometimes an aching of the shoulder and catching sensations are felt. Often athletes don’t trust their shoulders especially with overhead activities.

Traditional medicine basically has two options for people with Bankart lesions. Rest with a sling and some physical therapy or surgery to repair the labrum.

What most people don’t realize is that the chances of redislocating the shoulder are greater than 80% in patients younger than 30 years of age after a Bankart injury. This is why treatment is necessary. One of the main problems with surgery is that it takes at least six months to heal after surgery. Plus this does not mean that the athlete will be at the same level he/she was before the injury in six months. I would say it would take another six months. In our experience, athletes who get open (surgery where they use a scapel versus an arthroscope) Bankart surgery will plan to not be at presurgical athletic ability for a good year. Compare this to Prolotherapy where the process is often just three to four months.

What are the risks with the Bankart procedure?
• Perioperative: death from anesthesia. Nerve damage during surgery and poor placement of anchor sutures.
• Within six weeks after surgery: wound infection and rupture of the repair.
• Between six weeks and six months: Shoulder stiffness, recurrence of instability, failure of repair resulting in shoulder weakness, failure of anchor sutures.

What is an athlete or person to do who has a Bankart lesion?
I hope that you, like the person in the email did, consider Prolotherapy. Prolotherapy, in my opinion, is the best alternative to Bankart surgery. Surely, most surgeries should be reserved as the last option when all conservative measures have failed.

In its simplistic terms, a Bankart lesion is an injury to the inferior glenohumeral ligament which makes up part of the glenoid labrum. What is the best treatment you can find to help a chronic ligament heal completely? Prolotherapy, correct. For the athlete, get aggressive Prolotherapy to the unstable shoulder every two weeks or so. It may take four to ten visits, but it will be well worth it. Another plus is an athlete can continue to train while getting Prolotherapy treatment.

So instead of sending Caring Medical an email after you have had open Bankart surgery or after you have had Prolotherapy fail elsewhere , come to Caring Medical for treatment. We have a lot of experience. Plus being a four-time Ironman finisher and having had Prolotherapy on my shoulders, I understand that we need to get you back to full athletics as soon as possible.

PS: Sometimes with a traumatic shoulder dislocation, a humeral head indentation fracture occurs which is called a Hill Sachs lesion. So Bankart lesions and Hill Sachs lesions often occur together. What is the best treatment option for a Hill Sachs lesion? May I suggest you re-read this above article, because the recommendations are the same!