Q&A: Mike Reinold #2

Shoulder Capsule

In your experiences, is surgical tightening of the joint capsule by way of thermal shrinkage or arthroscopic knot-tying more successful? Which seems to fail at a higher rate? Which recovery seems quicker?

Both procedures you mention (thermal-assisted capsular shrinkage and capsular plication), can be successful in the right patient population.

Thermals have fallen out of favor as the ability to control the heat and the amount of “shrinkage” is difficult.  What literally happens is your collagen fibers shrink, but this involves a weakening of the tissue and a certain amount of necrosis.  If you have the wrong type of rehab this could be a disaster.  We had great success with this procedure in true overhead athletes, and our results have been published in the Journal of Orthopedic and Sports Physical Therapy and you can see our results were good.

But these were patients with acquired laxity from overhead sports.  Results of thermal in multi-directional instability patients, etc., were awful.  This sort of tainted the procedure as not being good and it would probably be hard to find someone that still does it.  I felt like we had good results but we also had the perfect patient and a good rehab approach.

Plication was sort of introduced as the next procedure after thermal.  It involves folding up a piece of the lax capsular tissue to take up the slack and then tying it down.  Again, this one is difficult to control the amount of tightening performed.

The procedure itself is OK and if you can’t pitch because you have too much anterior laxity this may help, but this injury and these surgeries are tough to come back from.  Anterior laxity is the kiss of death for an overhead athlete.  If you tighten it too much (or don’t get your motion back after surgery), you aren’t going to pitch well without symptoms, if you don’t tighten it enough you are back to square one.

Both recoveries are going to be 9-12 months and are challenging.  Good luck.

Mike Reinold is the Head Athletic Trainer and Assistant Director of Medical Services for the Boston Red Sox.  He’s also the Coordinator of Rehab Research and Education at the Massachussets General Hospital Sports Medicine Division.

You can find him online at MikeReinold.com.


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