Myers, J. B., Gatti, J., & Lephart, S. M. (2001, July). Learning curve looms for capsulorrhaphy. Biomechanics, 8.

BACKGROUND

The shoulder (glenohumeral) joint is the most mobile in the body. Because it is so mobile, it sacrifices stability. Stability at the shoulder must come from the soft tissues that span the joint, such as the joint capsule. However, the capsular tissues can become loose and overstretched from a prior injury like a dislocation or subluxation. When these tissues become overstretched, the head of the humerus may move around in the glenoid fossa. An individual with this degree of extra mobility in the joint is said to have instability of the shoulder.

Shoulder instability is a significant problem for several reasons. The instability can irritate local tissues in the area causing pain in the shoulder. In addition, the instability can be the cause of numerous other shoulder problems including shoulder impingement syndrome, recurrent dislocations, glenoid labrum injury, rotator cuff tears, or the development of myofascial trigger points.

Consequently, clinicians are always on the lookout for procedures that may help reduce instability at the glenohumeral joint. Traditionally open surgical procedures were the primary method of choice for dealing with capsular laxity and instability. Unfortunately these procedures also require a greater length of time in rehabilitation because of various tissues that may be damaged with the surgical procedure.

This article describes a new surgical technique for the treatment of shoulder instability that may significantly reduce the recovery time and get the individual back to activity much sooner. The procedure is called thermal capsullorraphy. It does not involve an open surgical procedure with a large incision like other capsular surgeries, but is an arthroscopic procedure.

Capsulorraphy is a term used to describe a method of making the capsule smaller or tighter. It has previously been done by open surgical procedures that suture the capsule. However, thermal capsulorraphy is done with heat instead of sutures. Once the arthrscopic incision is made, the tissue of the capsule is heated to the point that it shrinks, thereby reducing the excess mobility of the joint. Using an arthroscopic procedure dramatically reduces the healing time after the surgery since the incision is much smaller and there are fewer tissues disrupted.

The primary tools used to generate heat and shrink the capsule are laser and radio frequency thermal devices. Lasers have shown quite promising results in a number of other surgical procedures that are designed to remove damaged tissue. Ligamentous tissue of the capsule is primarily made of collagen. In this procedure the heat disrupts the molecular bonds in the collagen fibers causing them to collapse and shrink.

After the procedure it is important to keep the shoulder relatively immobile so that the heated capsular tissues do not stretch and produce more even movement. After the initial phase of mobilization, range of motion exercises will be started to help strengthen the muscles surrounding the joint and encourage a protected degree of motion.

DISCUSSION

Initial findings suggest encouraging results with thermal capsulorraphy. At the present time there is not a great deal of controlled studies that have evaluated the clinical effectiveness of this approach. Yet early clinical trials and empirical reports suggest this procedure may be very beneficial.

While an early degree of immobilization has been suggested to prevent excessive movement of the joint, there are problems that may exist with this approach. Immobilization of the shoulder after any surgical procedure is well known to be a cause of adhesive capsulitis (frozen shoulder) developing in the joint. It remains to be seen if this will become a complication in cases of thermal capsulorraphy as well.

Massage therapy can play a significant role in the management of the post-surgical patient with thermal capsulorraphy as well. The clinician will be trying to achieve a delicate balance between immobilization, restoration of proper motion, and pain management. Massage approaches may help reduce fibrosis in the area without contributing to capsular instability.

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