Re: Why do shoulder injuries heal better in adults than in children?

John,

A Bankart lesion often occurs as a result of instability of the 
glenohumeral (shoulder) joint or as a result of direct trauma to the 
shoulder.  The humerus, or bone in your upper arm, dislocates forward out 
of the glenoid, a shallow "socket" on your shoulder blade.  Check out an 
anatomy book to get oriented to the bones and parts of your shoulder.  It 
will help you follow this answer and understand what your surgeon plans to 
do to restore stability to your joint.

Your arm bone may move around excessively in the socket and when you 
injured it, it did move too far forward, right out of the socket.  The 
joint capsule, the membrane around the joint that holds the fluid in, was 
torn either at the capsular attachment to the humerus, or at the labral 
attachment to the glenoid.  The labrum is a cartilage structure around the 
edge of the glenoid that essentially deepens the socket.  When the humerus 
moves too far forward, the capsule or labrum it is attached to can tear.  
That's what you did at the glenoid labrum, it sounds like.  The capsule 
around the shoulder is very thick and tough, incorporating ligaments to 
help keep the humerus against the glenoid throughout the large motions the 
shoulder can achieve.  Without those ligaments and the capsule being 
attached very well to the glenoid, you risk re-injury of your shoulder and 
more problems as you get older.  

Older people heal better with this type of injury for a couple reasons.  
Number one, they are stiffer to start with.  Your problem is one of having 
too much motion, or instability, so your surgeon has to go in and tighten 
up the capsule to prevent future injury to your shoulder.  The second 
reason is that younger people are more active.  Who is more likely to land 
on their outstretched arm diving for a frisbee or football in the next 
four years, a seventeen year old, or a forty-five year old?  

But there is one thing you didn't ask about that is VERY important to the 
future of your arm.  You need to follow surgery with a good, safe 
strengthening program.  Specifically, you need to strengthen your teres 
minor and subscapularis.  These muscles come from your shoulder blade, 
under your arm pit, and around in front of your humerus.  They are 
considered internal rotators of your arm.  Due to their direction of pull, 
they can help protect your shoulder from dislocating forward if they are 
strong enough and you train them properly.  Make sure you talk to your 
surgeon about seeing a physical therapist after surgery to learn how to 
strengthen and protect your arm for future years.  

Good luck.  It should all go fine, but full recovery from this type of 
surgery does tend to take a little while.  Be patient and listen to your 
doctor and your therapist.

Sturdy McKee, MPT
2164 Market Street
San Francisco, CA 94114
415 350-3663