The use of arthroscopic thermal capsulorrhaphy to treat internal impingement in baseball players

Purpose: To determine if reducing glenohumeral translation by arthroscopic thermal shrinkage would improve the results of arthroscopic treatment of internal impingement in baseball players. Type of Study: Retrospective review. Introduction: Traditional treatment of internal impingement does not address the pathophysiology. Baseball players' shoulders routinely have glenohumeral laxity. Addressing this laxity by thermal capsulorrhaphy may improve the results in the treatment of these patients. Traditional treatment of labral and rotator cuff debridement and/or repair has had marginal results in regard to the most important criterion, return to competition. Methods: Charts of all patients undergoing surgical arthroscopy of the shoulder for suspected internal impingement were analyzed. Patients were divided into 2 groups: traditional treatment (non–heat-probe group, NHP, n=51) or traditional treatment plus thermal capsulorrhaphy (heat-probe group, HP, n=31). Internal impingement was confirmed by physical examination and arthroscopic criteria. All participants were baseball players and follow-up was 30 months. Data were analyzed for initial return to play and continued participation 30 months after surgery. Results: Mean time for return to competition was 7.2 months in the NHP group and 8.4 months in the HP group; 80% of the NHP group returned to competition compared with 93% of the HP group. At 30 months after surgery, 67% of the NHP group was back to competition compared with 90% of the HP group ( P =.01). The HP group averaged 7° less external rotation than before surgery. There were no significant complications in either group. Conclusions: Thermal capsular shrinkage can be safely used in the treatment of internal impingement in the throwing athlete. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 573–577