Name of the Procedure:

Capsulorrhaphy, Glenohumeral Joint (Any Type Multidirectional Instability)

Summary

Capsulorrhaphy is a surgical procedure used to restore stability to the shoulder joint, specifically the glenohumeral joint, by tightening the joint capsule. The procedure addresses cases of multidirectional instability, which means the shoulder can dislocate in multiple directions.

Purpose

Capsulorrhaphy is performed to correct shoulder instability that has not responded to conservative treatments like physical therapy. The main goal is to tighten the over-stretched or torn capsule of the glenohumeral joint, thereby preventing future dislocations and improving joint function.

Indications

• Recurrent shoulder dislocations
• Symptoms of shoulder instability (e.g., pain, weakness, limited range of motion)
• Failed conservative treatments such as physical therapy
• Active individuals or athletes who require a stable shoulder for performance

Preparation

• Patients may need to fast for a few hours before the procedure.
• Adjustments or discontinuation of certain medications as advised by the physician.
• Pre-operative diagnostic imaging (e.g., MRI, X-rays) to assess the extent of instability.

Procedure Description

1. Anesthesia: The patient is typically given general anesthesia.
2. Incisions: Small incisions are made around the shoulder.
3. Arthroscopy: An arthroscope (a small camera) is inserted to visualize the joint.
4. Repair: Special instruments are used to tighten the joint capsule and, if necessary, repair any tears.
5. Closure: The incisions are closed with sutures, and the shoulder may be dressed or immobilized in a sling.

Duration

The procedure generally takes about 1 to 2 hours, depending on the complexity of the case.

Setting

Capsulorrhaphy is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Infection
• Bleeding
• Nerve or blood vessel damage
• Joint stiffness
• Recurrence of instability
• Adverse reactions to anesthesia

Benefits

• Reduced incidence of shoulder dislocations
• Improved shoulder stability and function
• Decreased pain and discomfort
• Enhanced quality of life and ability to return to daily activities or sports

Recovery

• Post-procedure: Patients are typically monitored for a few hours before discharge.
• Instructions: Pain management through prescribed medications; wearing a sling to immobilize the shoulder.
• Physical therapy: Usually starts within a few weeks to restore function and strength.
• Full recovery: May take up to 6 months, with gradual return to activities.

Alternatives

• Physical therapy and strengthening exercises
• Shoulder bracing
• Other surgical options like shoulder arthroplasty or ligament reconstruction Each alternative has various pros and cons regarding recovery time, effectiveness, and invasiveness.

Patient Experience

• During: The patient will be under general anesthesia and will not feel discomfort during the surgery.
• After: Some pain and swelling can be expected, managed by medications and ice packs.
• Comfort: Use of a sling and careful movements to avoid strain on the repaired joint; follow-up appointments to monitor healing progress.