Shrink-to-Fit Shoulder Surgery Isn't for EveryoneEveryone and everything has a history. Keeping track of how things change over time is an important part of medical history. This is true for every disease, illness, and condition. This study reviews the history of treatment for shoulder instability. The authors also report the results of a new treatment.
Nineteen patients with multidirectional instability were treated and followed for at least two years. Multidirectional instability means the shoulder joint is too loose and moves too much. The extra motion is called joint laxity. This laxity occurs in one or more directions (down, forward, or back).
Treatment was with thermal shrinkage, which uses heat to tighten up the shoulder capsule that surrounds the shoulder joint. The capsule normally helps the joint stay stable. Thermal shrinkage can be done with lasers or with radiofrequency waves. Laser devices are expensive. Doctors must have special training to use this method. Radiofrequency is more popular now because it's easier to use and cheaper.
One doctor treated all 19 shoulders. Each patient's capsule was viewed with a videoscope. This tool allows the doctor to look inside the joint and see it on a TV screen. The radiofrequency probe was passed over the tissue section by section until all sides of the capsule were heated. Radiofrequency was set at 40 watts. This raised the tissue temperature to 152 degrees F.
All 19 patients were young and active. Nine had a recurrence of the same problem within the first nine months. Four patients had some nerve damage under the armpit, and one had muscle weakness. The authors report this high failure rate is not acceptable.
They suggest failure may be more likely when the patient has mostly posterior (backward) instability. Patients who can pop the shoulder in and out are also less likely to have a good result. It may be better to repair the shoulder in these patients using the usual methods of open or arthroscopic surgery with stitches to tighten the capsule.
Anthony Miniaci, MD, FRCSC, and Julie McBirnie, MD, FRCs (Orth). Thermal Capsular Shrinkage for Treatment of Multidirectional Instability of the Shoulder. In The Journal of Bone and Joint Surgery. December 2003. Vol. 85-A. No. 12. Pp. 2283-2287.
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