Posterior glenohumeral thermal capsulorraphy, capsular imbrication and labral repair with complication of adhesive capsulitis: a modified rehabilitation approach.

BACKGROUND Isolated atraumatic posterior glenohumeral instability is rare. Use of thermal capsulorraphy for glenohumeral instability is considered controversial. This case study describes a modified rehabilitation protocol for a patient who underwent a multistep arthroscopic procedure for isolated posterior glenohumeral instability with a postoperative complication of adhesive capsulitis. CASE DESCRIPTION A 30-y-old man with a 15-y history of bilateral posterior glenohumeral instability related to generalized hypermobility underwent right-shoulder arthroscopy consisting of a combined posterior labral repair, capsular imbrication, and thermal capsulorraphy. A gunslinger orthosis was prescribed for 6 wk of immobilization. Adhesive capsulitis was diagnosed at the 5-wk postoperative visit and immobilization was discontinued. A modified treatment protocol was devised to address both the surgical procedures performed and the adhesive capsulitis. Residual symptoms resolved with release of an adhesion while stretching 10 months postoperatively. OUTCOMES Scores of 5 shoulder-assessment tools improved from poor to excellent/good with subjective report of a very good outcome. DISCUSSION The complication of adhesive capsulitis required an individualized treatment protocol. In contrast to the standard protocol, our modified approach allowed more time to be spent in each phase of the program, was aggressive with restoring range of motion (ROM) without excessively stressing the posterior capsule, and allowed the patient to progress to activities that were tolerated regardless of protocol phase. Shoulder stiffness or frank adhesive capsulitis after stabilization, as in this case, requires a more aggressive modification to prevent permanent ROM limitations. Conversely, patients with early rapid gains in ROM must be protected from overstretching the repaired tissue with a program that allows functional motion to be incorporated over a longer time frame. This study indicates the use of thermal capsulorraphy as a viable surgical modality when it is used judiciously with the proper postoperative restrictions and rehabilitation.