Introduction

The thermal assisted capsular shift procedure is a new surgical technique that employs radiofrequency thermal stimulation to tighten the shoulder capsule. The thermal stabilization procedure has met with very encouraging early results and a high patient satisfaction rate. However, as in many shoulder procedures, the initial and ultimate tensile strength of the tightened capsule is unknown. Therefore, a fairly conservative early rehabilitation program is described below, followed by a progressive strengthening program of the rotator cuff and scapular stabilizers to encourage dynamic stabilization of the glenohumeral joint.

First Two-Three Weeks Post-op

Surgery is performed on an outpatient basis and the patient is kept in a sling or shoulder immobilizer post-operatively. The patient returns for first postoperative check-up within the first week. The shoulder is kept in the sling or immobilizer until approximately the second or third week post-operatively. The actual length of immobilization is made at the time of surgery and depends on the degree of shoulder laxity present. This will be included in the patients prescription provided.

During the first ten days, only range of motion at the wrist and elbow are permitted without abduction, flexion, or external rotation past 0^o . After the first 10 days, active abduction is permitted.

Three to Four Weeks Post-op

During this time period external rotation is allowed to 45^o with the elbow at the side and 45^o with the arm abducted to 90^o. Forward flexion and abduction are limited to 90^o each and extension to 20^o beyond the body plane. Within these ranges of motion, strengthening and progressive resistive exercises of the shoulder are encouraged but no passive stretches beyond these ranges are allowed. Shoulder shrugs and scapular retraction is encouraged to maintain the tone of the shoulder girdle. Progressive resistive exercises at the elbow and wrist are encouraged.

Four to Eight Weeks Post-Op

Full rehabilitation of the operated shoulder is allowed including scapular patterns, internal and external rotation as well as deltoid strengthening. Shoulder PNF patterns are continued. Resistive exercises can include manual resistance, elastic tubing, free weights, and shoulder strengthening equipment including wall pulleys. The only limitation to motion is that external rotation is limited to –15^o as compared to the opposite side. Although the patient may achieve external rotation greater than this on their own, passive stretching should be stopped at 15^o less than the opposite shoulder in forward flexion, abduction, and especially external rotation. It is preferable to allow the patient to regain the last 15^o “on their own” over time rather than stretch the capsule early compromising the repair. There should be a strong emphasis on continued scapular stabilization (protraction, retraction, and elevation).

Beyond Eight Weeks

The patient proceeds with a self-directed gym program that emphasizes PNF shoulder patterns, chest press, chest pulls, and a complete shoulder conditioning and endurance program. This may be monitored once or twice a month by a physical therapist to make any necessary adjustments. The patient is not to return to strenuous overhead sports or work activities, including overhead flexion or throwing until at least 12 weeks post-op. At that time the patient can continue to increase activities as tolerated with no limitations. Patients may feel “capable” of using the shoulder far sooner than this recommendation but precaution should be emphasized to prevent stretching of the thermally modified tissue.

Any questions concerning the above protocol should be directed to the physician at

(202) 444-8613.