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Shoulder Capsule Shrinkage
Capsular shrinkage, or thermal capsulorrhaphy, of the shoulder is an arthroscopic surgical procedure performed on an unstable joint to tighten the loose capsule.This surgery involves placing a special probe which emits high radio frequency waves directly onto the loose capsule. This alters the properties of the collagen structure causing the capsule to shrink and tighten.
The shoulder is comprised of the humerus, scapula and clavicle which join together to for the complex joints of the shoulder. The humerus articulates with the scapula, sitting in a shallow cavity called the glenoid. Here the shoulder is lined with articular cartilage and reinforced through ligaments, tendons and muscular attachments. Surrounding the complex is a capsule, a flexible elastic structure, which allows for the substantial range of movement produced. However, this design means that the shoulder is an inherently unstable joint which predisposes the joint to dislocations. With excessive capsular laxity the shoulder becomes prone to multidirectional instability (shoulder dislocations in different directions). When all conservative methods have been exhausted a capsular shrinkage can be performed to help prevent these dislocations and stabilise the shoulder.
Above: Soft tissue massage and mobilisations of the shoulder muscles and connective tissuePhysiotherapy Prior to Capsular Shrinkage
Prior to capsular shrinkage, physiotherapy can be a highly useful intervention. It will help to manage immediate symptoms, provide stability to the joint through improving strength and maintain functional independence to as high a degree as possible. Surgery is an option when all conservative methods have been exhausted. Treatment options available through Physio.co.uk include:
- Cryotherapy
- Pain management
- Strength Programme
- Stability Programme
- Advice and post surgical management
Symptoms Following Capsular Shrinkage
Following capsular shrinkage of the shoulder, your shoulder will be placed in a sling in order to protect and aid recovery. It is normal for you to experience symptoms due to the nature of the surgery and the anaesthetic. Symptoms may include:
- Pain
- Swelling
- Stiffness
- Bruising
- Numbness – will usually self resolve after the anaesthetic has wore off
Physiotherapy Following Capsular Shrinkage
Following capsular shrinkage of your shoulder, Physio.co.uk will compile a thorough and detailed assessment highlighting specific therapeutic needs as well as the setting of personal goals. Acute symptoms will be managed immediately and a rehabilitation programme will be developed in order to meet your surgery milestones and improve movement, strength and function of your shoulder.
Weeks 1-3
During the first 3 weeks following capsular shrinkage, it is essential to manage acute symptoms to minimise post operative complications and allow for optimal healing. Early mobilisation will commence as well as basic stability exercises for your shoulder. Treatment will include:
- Pain management
- Wound management
- Cryotherapy
- Electrotherapy
- Postural education
- Scapular stability
- Pendular exercises
- Passive and active assisted range of movement exercises
- Elbow, wrist and hand exercises to prevent stiffness and atrophy
- Sling mobility
- Home exercises
- Advice and education
Weeks 4-6
Following 3 weeks of rehabilitation following capsular shrinkage, Physio.co.uk will now focus on mobilising your shoulder to prevent stiffness and contractures as well as begin strengthening work of the shoulder musculature. You will be advised to stop wearing your sling and progress with a more intense physiotherapy programme. Physio.co.uk will direct treatment towards attaining functional and personal goals. Treatment will include:
- Active, passive and active assisted range of movement exercises
- Scapular stabilising exercises through range
- Rotator cuff strengthening
- Shoulder strengthening
- Joint mobilisation
- Soft tissue release
- Capsule stretching
- Proprioceptive training
Weeks 7-12
After 6 weeks of physiotherapy following capsular shrinkage, Physio.co.uk will intensify your programme focussing on a continuation and progression of exercises. Strengthening throughout range will provide greater stability to your shoulder and muscular endurance helping to fight fatigue. Our target will be to attain full range of accurate biomechanical movement and integrate sport specific exercises into the regime. Treatment will include:
- Range of movement exercises to achieve full range
- Joint mobilisation
- Soft tissue release
- Scapular stabilising towards outer range of shoulder movement
- Shoulder strengthening
- Proprioceptive and perturbation exercises
- Muscular endurance
- Begin sport specific exercises
- Encourage functional activities
Weeks 12+
Following 12 weeks of intense physiotherapy with Physio.co.uk, your shoulder will have regained full movement, a substantial increase in strength and a significant reduction in pain. Muscular endurance and control will have returned to normal allowing you to participate without hesitation in any sport or heavy occupation activities. Focus from here is on attaining complete functional independence and the achievement of personal goals. Physio.co.uk will provide a comprehensive long term rehabilitation programme so that you are able to return to your previous level of function. Treatment will focus on:
- Advanced strengthening
- Achieve full range of movement and strength
- Advanced proprioceptive exercises
- Sport specific exercises with a focus on returning to sport
- Functional training
- Advice on long term management
Summary
Capsular shrinkage, or thermal capsulorrhaphy, is an arthroscopic procedure performed on severely unstable shoulders that regularly dislocate. It is an arthroscopic procedure where the capsule is heated, shrinking and tightening the capsule in the process. With recurrent dislocations, the shoulder capsule becomes lengthened and loose predisposing the shoulder to further dislocations. This will then provide increased stability at the shoulder to prevent future dislocations. It is essential to have physiotherapy with Physio.co.uk to help rehabilitate and return optimal function to your shoulder. Physio.co.uk will provide a comprehensive and specific rehabilitation programme focussed on personal goals to help ensure the full recovery of movement strength and function. Call Physio.co.uk now on 0330 088 7800 for more information or to book an appointment please contact us.
