The inferior capsular shift operation for instability of the shoulder

Abstract

We reviewed 26 patients with 34 shoulders treated by the inferior capsular shift operation for inferior and multidirectional instability. The mean follow-up was 8.3 years. In total, 12 shoulders showed voluntary subluxation. Eight operations used an anterior and posterior approach, 11 were by the posterior route, and 15 shoulders had an anterior approach. In 30 shoulders (85%) the outcome was satisfactory and 20 (59%) scored good or excellent results on the Rowe system. Instability had recurred in nine shoulders (26%) from three months to three years after the operation. Six of the 12 shoulders with voluntary subluxation (50%) had recurrence, as against three of the other 22 (14%), a statistically significant difference. The operation is therefore not indicated for voluntary subluxation. The 19 shoulders which had been assessed in 1987 at a mean of 3.5 years after surgery, were also reviewed in 1995 and found to have no significant changes in instability or Rowe score. This shows that the capsular shift appeared to have maintained its tension over an eight-year period. After the use of a posterior approach, 64% of the shoulders showed a posterolateral defect on radiographs of the humerus.

Glenohumeral joint volume reduction with progressive release and shifting of the inferior shoulder capsule

“…Numerous studies have established the efficacy of the ICS procedure for the treatment of MDI. 2,3,4,6,10,12,17,19,20 However, no study has yet determined the relationship between degree of capsular release from the humeral neck and the amount of glenohumeral joint volume reduction with a humeral based capsulorraphy. The purpose of this study was to measure glenohumeral joint volume and reduction of the inferior axillary recess sequentially after the progressive release and shift of the inferior shoulder capsule.…”

Treatment of ligament laxity by electrothermal shrinkage or surgical plication: A morphologic and mechanical comparison

“…When nonoperative treatment fails, open surgical stabilization by use of the Neer inferior capsular shift procedure has been recommended, 9 although recent longer-term reviews of the outcome after this operation have revealed relatively high recurrence rates. 3 Arthroscopic thermal stabilization has been proposed as an alternative for these patients, as it offers a minimally invasive approach, reduced hospital stay, and potentially less perioperative morbidity. Unfortunately, despite encouraging early reports, 10 recurrence remains a problem clinically 1,8 ; conflicting clinical results have led to a variable uptake of this technology.…”

Therapiekonzept nach traumatischer Schulterluxation

“…In der Literatur wurde eine Vielzahl unterschiedlicher Stabilisierungstechniken publiziert, wobei die anatomisch orientierten Verfahren die besten Ergebnisse aufweisen [3,10,11,16,18,21,22,25,26,34,36]. Zur Rekonstruktion des abgelösten Kapsel-Labrum-Komplexes hat sich zwischenzeitlich die Refixation mittels Fadenankern etabliert [11,13,17,26,40] (Abb.…”

“…4). Zur Reduktion eines ausgedehnten Kapselvolumens wird der offene vordere Kapselshift mit lateraler Basis bevorzugt [2,9,13,16,21]. Die laserinduzierte oder thermische Kapselschrumpfung kann arthroskopisch durchgeführt werden.…”