Shoulder Instability

The range of motion of the shoulder joint is greater than any other joint. We can place and rotate our arms in front, above, to the side and behind our bodies. However, this exquisite flexibility makes the shoulder joint susceptible to instability and injury. Although the ligaments, tendons, muscles, and cartilage that form a capsule around the joint to maintain stability, trauma or overuse of the shoulder can cause these tissues to stretch or tear. Without the strong support of these tissues, the shoulder joint will feel “loose” and may pop out of the socket with certain activities. Generally, an unsupported instable shoulder will be weak and painful.

With advances in arthroscopic techniques, a new procedure called Thermal Capsulorrhaphy attempts to treat shoulder instability. This procedure uses heat to “shrink” and tighten the capsular tissues, especially the tendons and cartilage, at the molecular level. The body perceives the contraction of the fibers as an injury and the tissues rebuild around the shorter collagen fibers, resulting in a tighter, and theoretically more stable, shoulder.

Thermal Capsulorrhaphy is an outpatient procedure performed under general anesthetic and usually takes less than 30 minutes. Two pencil-sized arthroscopic instruments are used through small incisions that the surgeon makes in the arm. One of the instruments is for viewing the joint, while the other provides the heat that “shrinks and constricts” the joint tissue.

Postoperatively, an arm sling should be worn for about 3 weeks to allow the tissues to heal in their shortened state. A rehabilitation program to restore range of motion and strength will also be prescribed. Patients may be able to safely return to designated sports within 4 to 6 months after surgery.

Although thermal capsulorrhaphy cannot be used to treat all cases of shoulder instability, it can be beneficial for certain types of instability in some patients. However, because the procedure is very new, studies looking at long term results are not yet available. Your options should be discussed thoroughly with your doctor, as many factors including the degree of laxity and the underlying cause of instability play a role in determining appropriate treatment.