Electrothermally-Assisted Capsulorrhaphy (ETAC): A New Surgical Method for Glenohumeral Instability and Its Rehabilitation considerations

Abstract

Knowledge of current surgical procedures and the effect they have on healing tissue is important when developing rehabilitation guidelines. Recently, clinicians have been asked to treat patients who have undergone Electrothemally-Assisted Capsulorrhaphy (ETAC) for shoulder instability. The ultimate tensile strength of the tightened capsule is unknown during various timeframes following surgery. The use of thermal energy to shrink the shoulder joint capsule initially causes weakness of the collagen ultrastructure. Rehabilitation following ETAC includes a period of relative immobilization, followed by controlled range of motion exercises. Exercises to strengthen shoulder muscles must be done in a manner that minimizes stress on the surgically treated capsule. This article provides a brief review of capsuloligamentous repair; describes the surgical procedure, its indications, contraindications, and the effect ETAC has on the healing tissue; and provides guidelines for rehabilitation following ETAC based on the evidence available and the authors clinical experience. ) Orthop Sports Phys Ther 2000;30:390-400.

Shoulder Instability: Management and Rehabilitation

“…vent overstretching of tightened capsular tissues, particularly after thermal shrinkage procedures that induce an initial decrease in collagen tensile strength. 95,98 We restrict axial loading of the upper extremity for 6 weeks. For cases with an anterior component of instability, we restrict external rotation range of motion to 30°(0°abduction) for the first 4 postoperative weeks and avoid combined external rotation and abduction range of motion for the first 6 postoperative weeks.…”

Rehabilitation Following Thermal-Assisted Capsular Shrinkage of the Glenohumeral Joint: Current Concepts

“…Some clinicians have reported that it is easier to control the temperature (maintain a constant temperature) using the radiofrequency versus the laser method. 29,39,56 …”

“…Some clinicians have advocated immobilization during the first 2 to 4 weeks while others have suggested gentle restricted motion. 13,56 Most rehabilitation programs have been based on anecdotal clinical observations and preliminary data. In this section, we begin by discussing previously published rehabilitative programs.…”

“…Tyler et al, 56 describing their surgical technique and rehabilitation considerations using thermal energy, recommended that the shoulder be placed in a sling with a swathe for 3 to 4 weeks. Active-assisted ROM and strengthening exercises were initiated at 4 weeks and gradually progressed as tolerated.…”

“…Despite the dramatic increase of knowledge regarding thermal modification of soft tissues over the past few years, no unanimity of opinion regarding the usefulness or appropriateness of this technique exists. 13,14,16,21,25,39,40,48,56,64 Furthermore, there appears to be controversy in the postoperative management of these patients. 13,48,56 The purpose of this paper is to discuss the current knowledge of the treatment of joint instability using thermal-assisted capsular shrinkage (TACS) and postoperative rehabilitation in the overhead athlete.…”