Thermal capsular shrinkage in the throwing athlete
Section snippets
History and physical examination
It is distinctly unusual for a throwing athlete to report that his or her shoulder is “loose” or “unstable.” In most cases, the athlete will report pain in their shoulder, which occurs at typical points in the throwing motion. Many throwers experience pain when the arm is abducted and maximally externally rotated (late cocking and early acceleration phases of throwing). It is also common for throwers to report pain, which occurs after ball release, during the deceleration phase of throwing. The
Treatment
“Rotational Instability” is a term being used to describe the ability of the throwing shoulder to over-rotate into a position of hyper-external rotation. It is at this time during the throwing motion that the undersurface of the rotator cuff may become entrapped between the humeral head and posterior superior glenoid labrum. This condition has been termed “internal mpingement” by Walch et al [3]. Repeated occurrence of this impingement may lead to fraying of either the labrum or rotator cuff,
Results
Although the number of reports regarding the application of thermal energy to tissues is increasing rapidly, only a few reports have dealt specifically with the use of this technology in throwing athletes.
Anderson et al at The Hospital for Special Surgery reported on over 80 patients who were primarily overhead throwers [7]. Most were able to return to a presurgical level of competition. From our institution, Levitz reported on two groups of throwers with internal impingement [8]. The first
Summary
The role of thermal capsular shrinkage in treating various forms of pathology continues to evolve. The addition of thermal capsular shrinkage to the treatment regimen of standard pathologies in the thrower's shoulder has increased the rate of return to play even at the highest levels. Our data indicate an approximate 20% improvement in the rate of return to play with the addition of thermal capsular shrinkage to traditional treatments.
These data represent relatively short-term follow-up. Longer
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Electrothermal arthroscopic capsulorrhaphy: Old technology, new evidence. A multicenter randomized clinical trial
2014, Journal of Shoulder and Elbow SurgeryThe use of thermal shrinkage for scapholunate instability
2011, Hand ClinicsCitation Excerpt :Tissue repair occurs by vascular invasion and fibroblastic activity. Thermal shrinkage has been used in experimental and clinical settings to alter capsuloligamentous mechanical properties including the joint capsule (glenohumeral, patellofemoral), ligaments (medial collateral ligament of the knee), and tendons (patellar and extensor tendons, Achilles tendon).27 What has been learned is that discrete or punctate heating promotes better healing after shrinkage by leaving islands of normal tissue and that tissue after shrinking requires immobilization.
Thermal Capsulorrhaphy
2008, Surgical Techniques of the Shoulder, Elbow and Knee in Sports MedicineThermal Capsulorrhaphy
2008, Surgical Techniques of the Shoulder, Elbow, and Knee in Sports Medicine: Expert Consult - Online and PrintFluid temperatures during radiofrequency use in shoulder arthroscopy: A cadaveric study
2007, Journal of Shoulder and Elbow SurgeryCitation Excerpt :However, short-term studies have demonstrated success alone or in combination with suture augmentation.⁎ The greatest success appears to be in overhead athletes,3,39 whereas other investigators have shown poor results and caution against using this technique in patients with multidirectional instability.1,2,12,33 Several studies have examined the potential complications related to the use of thermal energy for tissue shrinkage in the shoulder.14,15,18,36,37,42,44
Effect of simulated shoulder thermal capsulorrhaphy using radiofrequency energy on glenohumeral fluid temperature
2005, Arthroscopy - Journal of Arthroscopic and Related Surgery