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Shrinking Long-Term Results after Thermal Shrinkage

Just because something is popular doesn't mean it's good. This idea is true in the medical world, too. Doctors from the Shoulder and Elbow Center point out that thermal shrinkage of the shoulder joint capsule is a very popular operation. But there isn't much research to back it up.

The purpose of this study was to see how well thermal shrinkage works for shoulder problems. Thermal shrinkage involves applying heat to the capsule around the shoulder to tighten it up. The procedure is called electrothermal capsulorrhaphy. Laser light or radiofrequency (RF) electrical current is used. The tissue is heated up then cooled down. This shrinks the tissue and forms scarring or thickening.

After shoulder dislocation, the capsule gets stretched out and doesn't go back to its normal shape. When the shoulder dislocates over and over, the joint becomes even more unstable. That's the most common reason to try thermal shrinkage. Doctors like the idea of thermal shrinkage because it can be done using an arthroscope without opening up the entire joint.

In this study, 84 patients were put into three groups: those whose shoulders popped out forward; those with a partial dislocation either forward or downward; and those with dislocation that occurred in more than one direction. After treatment with thermal shrinkage, each patient was examined using four measures. These measures included patient satisfaction, return to work or sport, shoulder function, and signs of instability.

Patients were followed for an average of three years. About two-thirds of the patients had an excellent or good outcome. However, almost 40 percent of the patients rated an unsatisfactory result. At first these patients reported good results. After a year things started to change. Painful symptoms came back, and shoulder dislocations occurred again. Some patients ended up needing another operation.

The authors say the goal of thermal shrinkage for an unstable shoulder is to get the same result as with open surgery. The poor long-term results for over one-third of the patients in this study are a big concern. These doctors conclude that the operation shouldn't be used routinely until more studies are done. When it is used, patients should be followed long term.

References: Donald F. D'Alessandro, MD, et al. Prospective Evaluation of Thermal Capsulorrhaphy for Shoulder Instability: Indications and Results, Two- to Five-Year Follow-up. In The American Journal of Sports Medicine. January/February 2004. Vol. 32. No. 1. Pp. 21-33.

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