The Journal of Bone and Joint Surgery (American) 85:2283-2287 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.
Thermal Capsular Shrinkage for Treatment of Multidirectional Instability of the Shoulder
Anthony Miniaci, MD, FRCSC1 and
Julie McBirnie, MD, FRCS(Orth)1
1 Sports Medicine Orthopaedic Program, University of Toronto, Toronto Western
Hospital, University Health Network, 399 Bathurst Street, ECW 1-036, Toronto,
ON M5T 2S8, Canada
Investigation performed at the Sports Medicine Orthopaedic Program,
University of Toronto, Toronto Western Hospital, University Health Network,
Toronto, Ontario, Canada
The authors did not receive grants or outside funding in support of their
research or preparation of this manuscript. They did not receive payments or
other benefits or a commitment or agreement to provide such benefits from a
commercial entity. No commercial entity paid or directed, or agreed to pay or
direct, any benefits to any research fund, foundation, educational
institution, or other charitable or nonprofit organization with which the
authors are affiliated or associated.
A commentary is available with the electronic versions of this article,
on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our
subscription department, at 781-449-9780, to order the CD-ROM).
Background: Capsular laxity is the main pathology in patients with
multidirectional instability, and thermal shrinkage has been commonly employed
to treat this condition. The objective of this study was to evaluate thermal
capsular shrinkage as a treatment of multidirectional instability of the
shoulder.
Methods: Nineteen consecutive patients with multidirectional
instability were treated with thermal shrinkage. Fifteen patients had
involuntary instability, and four had voluntary instability. The predominant
direction of the instability was anteroinferior in ten patients and posterior
in five; four patients had instability in multiple directions. Patients were
followed for a minimum of two years or until surgical failure and recurrence
of symptoms. Postoperatively, the patients wore a sling for three weeks, and
they were evaluated regularly at three, six, and twelve months. The Western
Ontario Shoulder Instability Index as well as subjective and objective
evaluations of the patient's function, range of motion, pain, and instability
were used as clinical outcome measures.
Results: Nine patients had recurrence of the instability at an
average of nine months (range, seven to fourteen months) following the
surgical procedure. Four patients had sensory dysesthesias in the axillary
nerve distribution, and one of them had deltoid weakness. All neurological
symptoms resolved within nine months. The surgical procedure failed in the
five patients with predominantly posterior instability. It failed in only two
of the ten patients with predominantly anteroinferior instability, and overall
this group had objective improvement.
Conclusions: Thermal capsular shrinkage used to treat
multidirectional instability had a substantial failure rate with associated
postoperative complications, including recurrence of instability (nine of the
nineteen patients), stiffness (five patients), and neurological symptoms (four
patients).
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.
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