HOME HELP CONTACT US SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Sign In to gain access to subscriptions and/or personal tools.

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McFarland, E. G. Articles by McCarthy, E. F. Search for Related Content PubMed PubMed Citation Articles by McFarland, E. G. Articles by McCarthy, E. F. Related Collections Shoulder Laser/Radiofrequency energy Histology

Histologic Evaluation of the Shoulder Capsule in Normal Shoulders, Unstable Shoulders, and after Failed Thermal Capsulorrhaphy

Edward G. McFarland, MD^*,, Tae Kyun Kim, MD, PhD^*, Prachan Banchasuek, MD^* and Edward F. McCarthy, MD

^* Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, Department of Pathology and Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland

Address correspondence and reprint requests to Edward G. McFarland, MD, 10753 Falls Road, Suite 215, Lutherville, MD 21093

Background: Attenuation of the shoulder capsule has been noted during revision surgery for failed thermal capsulorrhaphy.

Hypothesis: The attenuated capsule seen in patients who have undergone failed thermal capsulorrhaphy will show histologic characteristics distinguishing it from the capsule of normal shoulders and dislocating shoulders.

Study Design: Case control study.

Methods: The shoulder capsules were studied in 12 patients with traumatic anterior instability and in 7 patients who experienced recurrent instability after a thermal capsulorrhaphy. The capsules of six fresh-frozen cadavers with no shoulder lesions were used as controls.

Results: Among patients who had a history of traumatic instability, a denuded synovial layer was present in 58%, subsynovial edema in 58%, increased cellularity in 25%, and increased vascularity in 83%. At the time of surgery, five of seven shoulders in the failed thermal capsulorrhaphy group (71%) were subjectively felt to be thin and attenuated. Denuded synovium was found in 100%of these patients, subsynovial edema in 43%, and changes in the collagen layer in 100%. Changes in the collagen layer in these patients included a "hyalinization" appearance in five cases (71%), increased collagen fibrosis in two cases (29%), and increased cellularity in two cases (29%).

Conclusions: There was no one characteristic observable on histologic evaluation that would explain the attenuation of the capsule in cases of failed thermal treatment. Morphologic collagen structure can be histologically abnormal for up to 16 months after thermal capsulorrhaphy.

This article has been cited by other articles:

				L. J. Bisson Thermal Capsulorrhaphy for Isolated Posterior Instability of the Glenohumeral Joint Without Labral Detachment Am. J. Sports Med., December 1, 2005; 33(12): 1898 - 1904. [Abstract] [Full Text] [PDF]

				H. B. Park, A. Yokota, H. S. Gill, G. El Rassi, and E. G. McFarland Revision Surgery for Failed Thermal Capsulorrhaphy Am. J. Sports Med., September 1, 2005; 33(9): 1321 - 1326. [Abstract] [Full Text] [PDF]

				S. Chen, P. S. Haen, J. Walton, and G. A. C. Murrell The Effects of Thermal Capsular Shrinkage on the Outcomes of Arthroscopic Stabilization for Primary Anterior Shoulder Instability Am. J. Sports Med., May 1, 2005; 33(5): 705 - 711. [Abstract] [Full Text] [PDF]

				Y. Morag, J. A. Jacobson, G. Shields, R. Rajani, D. A. Jamadar, B. Miller, and C. W. Hayes MR Arthrography of Rotator Interval, Long Head of the Biceps Brachii, and Biceps Pulley of the Shoulder Radiology, April 1, 2005; 235(1): 21 - 30. [Abstract] [Full Text] [PDF]

				P. J. Millett, P. Clavert, and J. J.P. Warner Open Operative Treatment for Anterior Shoulder Instability: When and Why? J. Bone Joint Surg. Am., February 1, 2005; 87(2): 419 - 432. [Abstract] [Full Text] [PDF]

				M. D. Miller What's New in Sports Medicine J. Bone Joint Surg. Am., March 1, 2004; 86(3): 653 - 661. [Full Text] [PDF]

				D. F. D'Alessandro, J. P. Bradley, J. E. Fleischli, and P. M. Connor Prospective Evaluation of Thermal Capsulorrhaphy for Shoulder Instability: Indications and Results, Two- to Five-Year Follow-up Am. J. Sports Med., January 1, 2004; 32(1): 21 - 33. [Abstract] [Full Text]

				G. M. Gartsman and S. S. Hasan What's New in Shoulder and Elbow Surgery J. Bone Joint Surg. Am., January 17, 2003; 85(1): 171 - 181. [Full Text] [PDF]