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Management of Capsular Laxity

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Elite Techniques in Shoulder Arthroscopy

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Abstract

Capsular instability occurs when the glenohumeral joint capsule becomes so mechanically compromised that the remaining static and dynamic joint stabilizers cannot prevent symptomatic glenohumeral subluxation and/or dislocation. Most patients do not have a history of trauma and complain of activity-related pain. Physical examination identifies laxity, which should not be confused with instability. The clinician must distinguish between multidirectional instability with or without hyperlaxity, unidirectional instability with hyperlaxity, and glenohumeral hyperlaxity. Magnetic resonance imaging or arthrography may be used to evaluate the glenohumeral soft tissues and rule out the presence of other pathology that may contribute to glenohumeral instability. The objective of any rehabilitation, repair, or reconstruction is to impart sufficient stability to static and/or dynamic stabilizers to eliminate symptomatic subluxation and dislocation. A 6-month trial of physiotherapy is common. Examination under anesthesia determines the magnitudes and directions of laxity, which directs surgical treatment. Arthroscopic capsulolabral plication with or without interval closure is the mainstay of surgical stabilization. This technique shortens and reinforces the capsule while reducing capsular volume. While uncommon, trauma is the major risk factor for recurrent instability.

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Authors and Affiliations

  1. The Miami Hand and Upper Extremity Institute, Miami, FL, USA

    C. Edward Hoffler II PhD, MD

  2. Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Egg Harbor Township, NJ, USA

    Fotios P. Tjoumakaris MD

  3. Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Sewell, NJ, USA

    Luke Austin MD

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  1. C. Edward Hoffler II PhD, MD
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  3. Luke Austin MD
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Correspondence to Fotios P. Tjoumakaris MD .

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  1. Department of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    John D. Kelly IV

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Hoffler, C.E., Tjoumakaris, F.P., Austin, L. (2016). Management of Capsular Laxity. In: Kelly IV, J. (eds) Elite Techniques in Shoulder Arthroscopy. Springer, Cham. https://doi.org/10.1007/978-3-319-25103-5_7

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