Shoulder Stabilization (Capsulorrhaphy)
The shoulder joint capsule is an integral part of the glenohumeral joint, providing a balance between stability and mobility. It’s complex structure of fibrous tissue and synovial membrane that supports the bones while allowing a wide range of movements and lubricating the joint. Any injury or disease affecting the capsule can have significant implications for the shoulder’s function and may require medical intervention.
Shoulder stabilization, specifically through a procedure known as capsulorrhaphy, refers to surgical intervention aimed at treating instability of the shoulder joint. This instability can be the result of congenital factors, traumatic injury, overuse, or degenerative conditions that lead to a laxity or tearing of the ligaments and capsule surrounding the shoulder joint.
Capsulorrhaphy is a surgical procedure used to tighten the shoulder joint’s capsule when it becomes stretched or torn. It can be performed arthroscopically (using a small camera and specialized instruments through small incisions) or through a more traditional open surgical approach.
Shoulder stabilization is often required in cases of:
- Chronic shoulder dislocations or subluxations.
- Labral tears or damage to the ring of cartilage in the joint called the labrum. (Bankart repair)
- Ligamentous injuries in the shoulder.
- Chronic instability due to overuse, especially in athletes.
Capsulorrhaphy surgery may be performed arthroscopically or as an open procedure.
During the procedure, Dr. Reynolds will tighten the joint capsule by suturing it, removing any excess tissue, tightening the ligaments, and possibly using other methods to achieve the proper tension.
- Arthroscopic Capsulorrhaphy: Small incisions are made, and a camera along with specialized instruments are used to perform the procedure with minimal invasiveness. It offers good to excellent clinical outcomes after injury with favorable return to sport and high patient satisfaction rates. It addresses recurrent laxity by decreasing the size of the capsule using sutures, while also addressing labral tears and any other damage to the joint. It is preferred for its advantages including decreased pain, improved post-operative range of motion and faster rehabilitation allowing for faster return to play.
- Open Capsulorrhaphy: Open capsulorrhaphy is preferred in patients with multidirectional instability, underlying tissue hyperlaxity and who had 1 or more, previously failed, arthroscopic shoulder stabilization procedures.
Recovery involves immobilization with a sling or other immobilization device to protect the repaired joint for a short period, followed by guided rehabilitation and physical therapy to restore strength, flexibility, and function to the shoulder. Pain and inflammation are typically managed with appropriate medications. It may be possible to return to previous levels of sports, work or high demand activities at 6-12 months. Some patients might experience complete recovery by six months, while others may take up to a year to recover, especially if there were additional complexities or other tissue repairs.