THERMAL CAPSULORRHAPHY OF THE SHOULDER AND PHYSICAL THERAPY
Tid Bits of Info
- Thermal Capsulorrhaphy is not used successfully for all shoulder instability. Multi-directional instability and traumatic injuries do not respond well to this technique.
- The soft tissue that is surgically treated during the Capsulorrhaphy procedure takes approximately 6-8 weeks to heal.
- Thermal Capsulorrhaphy is a technique that utilizes a laser or radio frequency to heat the soft tissue and cause it to “shrink”.
- The best candidates for Thermal Capsulorrhaphy are individuals that suffer from uni-directional instability.
- If you have instability in your shoulder or have the Thermal Capsulorrhaphy procedure performed you will need to seek treatment from a Physical Therapist.
A common cause of shoulder pain can be shoulder instability. The shoulder may feel loose and even dislocate easily. Any instability in the joint can lead to pain, weakness and a decrease in functional use of the involved arm. The shoulder is the most mobile joint in the body, so any loss of motion can be severely limiting. Some types of instability can be successfully treated through a heat-based procedure known as Thermal Capsulorrhaphy.
Three bones intersect to form the shoulder joint: the scapulae (shoulder blade), the humerus (upper arm), and the clavicle (collarbone). The round humeral head is resting on a shallow, concave saucer-like glenoid fossa. There is a ring of fibrocartilage (the Labrum) and a soft tissue capsule (leather-like bag) that surrounds the head and “houses” it on the fossa. The Rotator Cuff (RTC) includes four muscles and tendons that connect the humerus to the scapulae. More specifically, the RTC muscles are responsible for keeping the humeral head on the glenoid fossa of the scapulae. The movement of the shoulder joint is dependent upon the humeral head’s articulation on this surface. If the Humeral head does not articulate in the center of the fossa, the shoulder is considered to have instability.
Treating Shoulder Instability
Shoulder joint instability can be in only one direction or multi-directional, but any instability will cause a decrease in the shoulder’s functional capabilities. The causes of the instability are numerous and can range from muscular weakness to traumatic dislocation of the joint. Treatment is focused on making the shoulder stable and improving the function. Initially exercise is recommended and sometimes surgery is required to help treat the underlying issue.
A Physical Therapist will instruct patients in a series of exercises designed to help the shoulder. If the exercise routine does not reduce the instability, healthcare professionals will use imaging studies along with the physical examination to help determine if the instability is too great. If so, the patient will most likely undergo a surgical procedure to “tighten” the joint and reduce the instability.
The surgeon must determine the extent of the instability. If it is great enough and repairing the damaged labrum is not sufficient to secure the joint, the surgeon might perform the Thermal Capsulorrhaphy procedure. During the surgical procedure a probe is inserted into the stretched out capsule and a high-frequency radio signal or laser is used to heat up the tissue. The heat changes the tissue at the cell level and makes it shrink (similar to plastic wrap that is held over a flame). The capsule becomes more taught and is capable of stabilizing the joint.
The Capsulorrhaphy procedure has been shown to be highly successful when it is performed in conjunction with a labrum repair (Bankart procedure) or performed on a uni-directional instability. When it is done as a sole procedure or on a shoulder joint that has multi-directional instability the rate of recurrent instability can be more than 60%.
Treating Shoulder After Thermal Capsulorrhaphy
The shoulder joint needs to be protected following this procedure. The capsule will heal at the new, shorter length if it is protected and not over-stretched for approximately 6-8 weeks. The patient will attend Physical Therapy shortly after the surgical procedure, but the therapist will be careful not to over-stretch the capsular fibers that were shrunk during the Capsulorrhaphy procedure. The initial rehabilitation focuses on pain control, swelling reduction and the initiation of exercises to re-establish the normal functional motions of the shoulder. The exercises will address all of the motion deficits and the muscles of the upper body including the core will be thoroughly trained and conditioned.
The surgeon might ask you to see a specific Physical Therapist. If no particular Physical Therapist is requested, you can seek treatment anywhere. You should try to find a Physical Therapist that specializes in shoulder rehabilitation and most out-patient orthopaedic Physical Therapists are qualified to rehabilitate this type of shoulder condition.
Shoulder instability is a common condition that affects a great number of people. Fortunately, there are ways to correct the instability and make the most mobile joint in the body completely functional without instability. One technique is Thermal Capsulorrhaphy which is used successfully on certain types of unstable shoulders. The surgical technique requires a period of protection and approximately 12-16 weeks of rehabilitation to regain most of the function required to perform the common activities of daily life.
I just witnessed a Bankart surgery last month. This was an interesting read because the surgeon only performed the bankart and did not even talk about the option of the thermal option to tighten the muscles. This is the first time I have read about this option and I like the idea of it, but believe more research should be done to determine if there is a better way to decrease the recurrent rate of instability after surgery.