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

Abstract

Glenohumeral joint instability is a common pathology observed in the orthopedic and sports medicine settings. Overhead athletes often exhibit a certain degree of acquired laxity that can lead to various pathologies. Unfavorable results often observed with traditional open procedures to correct instability in the overhead athlete have led to the development of arthroscopic thermal-assisted capsular shrinkage (TACS). TACS is not commonly used as an isolated procedure in overhead athletes; various procedures are often performed concomitantly. The overall outcome greatly depends on a postoperative rehabilitation program that must be assessed and adjusted frequently based on several factors. Knowledge of the basic science of TACS as well as emphasis on dynamic stabilization, proprioception, and neuromuscular control are vital to the rehabilitation program for overhead athletes. The purpose of this paper is to discuss the basic science and clinical application of thermal-assisted capsular shrinkage of the glenohumeral joint as well as the postoperative rehabilitation for the overhead athlete and the patient with congenital laxity and related multidirectional instability.

Thermal-Assisted Capsular Shrinkage of the Glenohumeral Joint in Overhead Athletes: A 15- to 47-Month Follow-up

“…4,[7][8][9]18 Thermal energy, in the form of heat, has been used in medicine dating back to Hippocrates. The authors of the current study 34 have previously discussed the basic science and clinical application of thermal-assisted capsular shrinkage (TACS) of the glenohumeral joint capsule. Since the 1990s, thermal energy has been used to modify capsular tissue in orthopedics 4,[7][8][9]18 and may be applied using 2 types of probes: the Holium:YAG laser and the radiofrequency heat probe.…”

Interval Sport Programs: Guidelines for Baseball, Tennis, and Golf

“…6,10,11 While the strengthening program should achieve a balance between anterior and posterior shoulder musculature, special emphasis should be given to the posterior rotator cuff and scapular musculature for any strengthening program. 9,10 The rehabilitation program should follow a sequential order of alternating days.…”

“…Because most sport motions involve the entire body, all muscle groups should be stretched prior to the ISP. Capsular stretches and shoulder ROM exercises 6,9,10,11 should be performed as needed before beginning the ISP. • Light ROM…”

“…9,10 Upon successful completion of the early phases of the rehabilitation program, a gradual and controlled return to sport activities has been advocated by several authors. 1,2,3,6,9,10,11 The term ''interval sport programs'' has been used to refer to functional rehabilitation guidelines that simulate sport activities. These programs are designed to progressively apply forces to the healing structures and are intended to gradually return the athlete to full athletic competition as quickly and safely as possible.…”

Modelo para estimativa da força e torque muscular durante a abdução do ombro

“…Além disso, os músculos do manguito rotador são frequentemente envolvidos em disfunções da articulação do ombro (26) . Ao longo da reabilitação de diferentes disfunções desta articulação, exercícios de reforço muscular para o manguito rotador são comumente recomendados (10,32,36,37) . Os programas de reabilitação de atletas envolvem ainda reforço dos músculos do manguito rotador com o ombro abduzido em 90°, devido à grande sobrecarga que esta articulação sofre nesta posição em esportes de arremesso (16,36) .…”