Shoulder proprioception and function following thermal capsulorraphy.
OBJECTIVE
Because monopolar radiofrequency energy has a denaturing effect on the glenohumeral joint capsule during thermal capsulorraphy, we hypothesized that thermal treatment would have a deleterious effect on the mechanoreceptors present within the capsule, thereby affecting proprioception and function. The purpose of this study was to evaluate proprioception and function following thermal capsulorraphy.


METHODS
Case series.


METHODS
Twenty subjects (13 male, 7 female) diagnosed with unilateral anterior, anteroinferior, or multidirectional glenohumeral instability with no significant concomitant pathologies, were treated with monopolar radiofrequency thermal capsulorraphy by one surgeon. Capsular redundancy was the primary diagnosis in all subjects. Subjects were bilaterally tested retrospectively 6 to 24 months (11.90 +/- 5.65 months) following surgery. Each subject's ability to actively reproduce joint positions (ARJP) and reproduce paths of motion (PMR) was measured with an electromagnetic motion analysis system. Both passive reproduction of joint positions (PRJP) and threshold to detect passive motion (TTDPM) were measured using a proprioception testing device. Function was quantified with the Shoulder Rating Questionnaire (SRQ). Proprioception data were analyzed with separate repeated measures ANOVA (P <.05).


RESULTS
Statistical analysis revealed a significant ARJP difference between the involved and uninvolved limb (P =.005) indicating that reproduction error was less with the involved limb compared to the uninvolved limb. No significant interactions were present for TTDPM, PRJP, or PMR. The SRQ indicates that the subjects returned to near normal function (91.86/100 +/- 5.38 points) at the time of testing.


CONCLUSIONS
The results from this study do not support our hypothesis of proprioception and functional deficits following thermal treatment. Normalized proprioception following thermal capsulorraphy may have resulted from the healing effects of thermal treated ligament, as reported in the literature, as well as facilitation of other mechanoreceptors present in adjacent tissue about the shoulder joint during rehabilitation. The results of this study indicate that no appreciative deleterious effects exist with proprioception and function following treatment of shoulder instability with thermal capsulorraphy.
Lephart
Scott M
SM
Neuromuscular Research Laboratory, Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15203, USA. lephartsm@msx.upmc.edu
Myers
Joseph B
JB
Bradley
James P
JP
Fu
Freddie H
FH
D000328:Adult; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods; D001696:Biomechanical Phenomena; D016022:Case-Control Studies; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D004056:Differential Threshold; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008465:Mechanoreceptors / Q000473:pathology / Q000502:physiology; D009068:Movement / Q000502:physiology; D011434:Proprioception; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D012684:Sensory Thresholds; D012782:Shoulder / Q000503:physiopathology* / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires