Date of Award

2001

Document Type

Scholarly Project

Degree Name

Master of Physical Therapy (MPT)

Department

Physical Therapy

First Advisor

Susan H.N. Jeno

Keywords

Joint Instability -- therapy; Shoulder Joint

Abstract

Glenohumeral joint instability is a clinical problem in both the athletic and general populations. When 3 months of conservative physical therapy treatments fail to stabilize the lax shoulder joint, surgery is indicated. Recently thermal capsulorrhaphy, an arthroscopic procedure that uses a heat probe to shrink redundant capsular tissue, has been offered as one alternative to tighten the lax glenohumeral joint capsule. There are numerous published reports describing the effects of thermal energy on joint capsular tissue, but only a few clinical outcome studies have been published regarding thermal capsulorrhaphy of the shoulder. Some initial reports of this surgical technique seem to be favorable for reducing shoulder instability in the overhead athlete and general population, but no long-term studies have been done to determine the efficacy of this surgical intervention. The purpose of this independent study was to review recent literature regarding thermal capsulorrhaphy, compare existing protocols, and to present an 18 month post operative clinical outcome of one collegiate tennis athlete who under went the thermal capsulorrhaphy procedure to his serving shoulder.

The findings of this study indicate that no one protocol has been established for this patient popUlation. The clinical outcome for the subject in this study was less than favorable as he was not able to return to playing collegiate tennis. Several of the contributing factors to this poor clinical outcome were identified, which included: too short of immobilization period following thermal capsulorrhaphy, no physical therapy interventions for 6 weeks postoperatively, and the performance of resisted shoulder extension exercises at six weeks postoperatively.

A physical therapist's understanding of collagen maturation process is imperative in designing a rehabilitation program for patients who have undergone thermal capsulorrhaphy of the shoulder because the ultimate tensile strength of the shrunk capsule is unknown at this time. Early physical therapy intervention and careful monitoring of patient range of motion to prevent re-stretching of the glenohumeral capsule are also crucial to a successful clinical outcome. Only more long-term clinical outcomes will determine if this will become the gold standard for treating shoulder instability.

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