Thermal Shrinkage for Shoulder Instability

Alison P. Toth, MD
Duke Sports Medicine Center


Russell F. Warren, MD

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College

Frank A. Petrigliano, MD
David Geffen School of Medicine


David A. Doward, MD
Jacksonville Orthopaedic Institute


Frank A. Cordasco, MD, MS
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College
Assistant Clinical Professor of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons


David W. Altchek, MD
Attending Orthopaedic Surgeon, Hospital for Special Surgery
Co-Chief, Sports Medicine & Shoulder Service, Hospital for Special Surgery
Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College


Stephen J. O'Brien, MD, MBA
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Attending Orthopaedic Surgeon, NewYork-Presbyterian Hosipital
Associate Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College
Vice Chairman of the Sports Medicine Department, Hospital for Special Surgery
Executive Sports Committee, Hospital for Special Surgery

Abstract

Thermal capsular shrinkage was popular for the treatment of shoulder instability, despite a paucity of outcomes data in the literature defining the indications for this procedure or supporting its long-term efficacy. The purpose of this study was to perform a clinical evaluation of radiofrequency thermal capsular shrinkage for the treatment of shoulder instability, with a minimum 2-year follow-up. From 1999 to 2001, 101 consecutive patients with mild to moderate shoulder instability underwent shoulder stabilization surgery with thermal capsular shrinkage using a monopolar radiofrequency device. Follow-up included a subjective outcome questionnaire, discussion of pain, instability, and activity level. Mean follow-up was 3.3 years (range 2.04.7 years). The thermal capsular shrinkage procedure failed due to instability and/or pain in 31% of shoulders at a mean time of 39 months. In patients with unidirectional anterior instability and those with concomitant labral repair, the procedure proved effective. Patients with multidirectional instability had moderate success. In contrast, four of five patients with isolated posterior instability failed. Thermal capsular shrinkage has been advocated for the treatment of shoulder instability, particularly mild to moderate capsular laxity. The ease of the procedure makes it attractive. However, our retrospective review revealed an overall failure rate of 31% in 80 patients with 2-year minimum follow-up. This mid- to long-term cohort study adds to the literature lacking support for thermal capsulorrhaphy in general, particularly posterior instability.

This article appears in HSS Journal: Volume 7, Number 2.
View the full article at springerlink.com.

About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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