1. THERMAL CAPSULLORRAPHY By: Elly Helget, Hanna Braun, Lacey Schipnewski, Kaitlyn Rayhill, & Tracy DeBeer

2. THERMAL CAPSULORRAPHY Surgical technique using heat to tighten and shrink the shoulder joint capsule Less invasive way to treat a shoulder that is loose or frequently dislocates Used in athletes that complete overhead movement Resulting in a posterior capsule injury

3. INDICATIONS Damage or deformation to the glenohumeral capsule and ligaments Micro trauma Congenital abnormalities Neuromuscular disorders Feeling of looseness Single subluxation or dislocation Pain and weakness that interferes with ADLs and hobbies. No prior shoulder surgery No multiple dislocations

4. CONCERNS Shoulder instability caused by traumatic injury that has damaged the tissues that require them to be reattached to bone People with multidirectional instability, causing the shoulder to dislocate in all directions

5. PROCEDURE 2-3 small arthroscopic incisions (also known as portals) A small probe is used to heat and shrink the tissue and restore normal capsular tension o Tissues being shrunk: glenohumeral ligaments, collagen fibers and labrum Procedure usually takes less than an hour

6. COMPLICATIONS OF SURGERY Adhesive capsulitis Destruction of the shoulder capsule Nerve injury Cartilage degeneration Arthritis

7. PHASES OF REHABILITATION Phase I: Initial Immobilization ROM wrist and elbow Codman’s exercises No shoulder abduction, flexion, external rotation

8. PHASES OF REHABILITATION Type of ProcedureLength of Immobilization Anterior stabilization with labral repair2-3 weeks Unidirectional stabilization without labral tear 3 weeks Posterior stabilization4-5 weeks Multi-directional instability4-6 weeks (depending on degree of instability)

9. PHASES OF REHABILITATION Phase II: Protected ROM Starts 2-4 weeks out of the sling Lasts 6-12 weeks Protected AROM No lifting, pulling, pushing more than 5 lbs Allowed ROM: 140 degrees elevation, 40 degrees ER with arm at side, IR with hitchhikers thumb to L1

10. PHASES OF REHABILITATION Phase III 9-12 Weeks Post-Op Pt. should achieve full shoulder ROM Strengthening can be progressed Lasts 4 weeks Exercises PROM as needed Rows with progressed T band strength and reps from phase II Push up progression with no elbow flexion greater than 90 on table Prone scapular retraction exercises with weight as tolerated. Rotator cuff strengthening

11. PHASES OF REHABILITATION Phase IV 12 weeks can begin weight lifting No lifting restrictions Avoid elbow flexion greater than 90 and overhead press or pull down behind head Sports with no contact or overhead motion resumed Exercises Progress to chair push up exercises with no elbow flexion Begin tossing ball overhead Progress weight with rotator cuff exercises Rows, Push, Pulls with T band Progress as needed

12. PHASES OF REHABILITATION For additional and more specific rehabilitation protocol for anterior capsulorraphy click the link below: http://www.orthonc.com/sites/default/files/forms/kirby/Anterior_Capsulorrhaphy_Anterior_ ETAC.pdf

13. RESULTS Earlier results showed positive results Recent results show a high failure rate and more complications Probes are not accurate and may cause excessive heat application Arthroscopic lavage solution temperature change the amount of thermal energy applied to the tissue. Failure rate contributers: Multidirectional instability Multiple subluxations or dislocations

14. BIBLIOGRAPHY https://www.bcidaho.com/providers/medical_policies/sur/mp_70182.asp http://orthoinfo.aaos.org/topic.cfm?topic=a00034 https://www.bcbsal.org/providers/policies/final/077.pdf www.smith-nephew.com/.../ surgical /v1-1061240b.pdf www.hughston.com/hha/a_13_2_5.htm http://www.healio.com/orthopedics/journals/ortho/2007-2-30-2/%7B548f978d-e66f-44a1-b975- 74c92028ff8a%7D/glenohumeral-chondrolysis-following-thermal-capsulorrhaphy http://www.orthonc.com/sites/default/files/forms/kirby/Anterior_Capsulorrhaphy_Anterior_ETAC.pdf http://www.smith-nephew.com/global/assets/pdf/products/surgical/v1-1061240b.pdf