Thermal Capsulorrhaphy

In recent years, arthroscopic techniques that use heat to “shrink” and tighten the tissues have been developed to treat several types of shoulder instability. The procedure, called thermal capsulorrhaphy (kap-sue-lore’-a-fee), uses heat to change the molecular structure of tissue.

Anatomy

No joint has greater range of motion than the shoulder. But, this flexibility is also a liability, because it makes the shoulder prone to dislocation and instability. The upper arm bone (humerus) sits in a saucer-shaped part of the shoulder blade (scapula), called the glenoid. A circle of ligaments, tendons, muscles, and cartilage form a capsule around the joint to maintain stability.

Indications

Trauma or overuse can cause these soft tissues to stretch or tear. Then they can no longer provide the necessary support. A feeling of “looseness” may develop and the shoulder may “pop out” with some activities. Pain and weakness may interfere with daily activities, such as work, sports, or sleep.

Thermal capsulorrhaphy is not appropriate for every patient. Some injuries that result from trauma, for example, may damage or tear tissue to such an extent that they require surgery to reattach the injured tissue. Other injuries caused by overuse can often be treated with rehabilitation first and surgery only if rehabilitation does not show improvement. The orthopaedic surgeon will identify various options, based on the underlying cause and the degree of looseness, or laxity, in the ligaments of the shoulder.

Technique

Tendons and ligaments are primarily composed of collagen, a type of protein. When collagen is heated to the appropriate temperature, it contracts and “shrinks.” The body perceives this as an injury and the tissues rebuild around the shorter collagen fibers. This results in a tighter, and theoretically more stable, shoulder.

Thermal capsulorrhaphy is an outpatient procedure performed while the patient is under regional or general anesthesia. The surgeon makes two or three small incisions, called portals, and inserts the pencil-thin arthroscopic instruments. One instrument enables the surgeon to view the joint and another provides the heat source.

The surgeon brushes the thermal probe back and forth across the tissues in the shoulder joint. He or she looks for changes in color and texture in the tissues as the probe touches them. The entire procedure usually takes less than 30 minutes.

Care After Surgery

There is little pain after surgery. The patient must wear a sling for at least three weeks and take care not to raise or turn the arm. This will stretch the tissues before they have healed in their shortened state.

Rehabilitation

The physician will prescribe a rehabilitation program. This will strengthen the muscles and restore a full range of motion. Patients may be able to safely return to certain sports in as little as four to six months.

Risks and Complications

Early studies suggest that thermal capsulorrhaphy may be beneficial in treating several kinds of shoulder instability. The technique is so new, however, that long-term results are not yet available. Some people may continue to experience shoulder instability and may eventually require open surgery to shorten and tighten the tendons. Others may develop stiffness or tightness of the joint (capsulitis).