Benefit of Thermal Capsulorrhaphy for Shoulder Questioned

In this review article, surgeons from the Cleveland Clinic Foundation report the overall results of thermal capsulorrhaphy (TC). TC is a heat treatment delivered by laser or radiofrequency energy. It has been used for the last 12 years in the treatment of shoulder instability.

This type of heat treatment causes the capsule around the shoulder joint to shrink and tighten up. It was hoped that overhead-throwing athletes with unstable shoulder joints could benefit from this procedure.

The results of TC have been hard to determine because it's not usually done alone. Most of the time TC is done along with surgery to repair tears in the labrum, a rim of cartilage around part of the shoulder socket.

From studying other reports, the authors give the following summary:

  • TC doesn't work well for patients with shoulder instability in more than one direction. This condition is called multidirectional instability (MDI).
  • TC has greater success in patients with MDI who also have a torn labrum.
  • TC is not advised for patients with just posterior shoulder instability.
  • It's unclear whether or not TC works for patients with instability in one direction (forward or backward) who also have a torn labrum.
  • TC seems like a good choice for patients with a loose joint; this condition is called joint laxity. More study is needed to show the long-term effects.

    The authors conclude that shoulder problems can be very complex. Surgeons are often treating patients who don't fit the classifications or categories discussed in studies. Recurrent pain and instability are common problems after TC with or without surgery.



    References: Anthony Miniaci, MD, FRCSC, and Michael J. Codsi, MD. Thermal Capsulorrhaphy for the Treatment of Shoulder Instability. In The American Journal of Sports Medicine. August 2006. Vol. 34. No. 8. Pp. 1356-1363.

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