Educational Article

Treatment for a Dislocating Shoulder Improved

By Dr. Robert Martin

If you lived in ancient Greece around 460 BC during the time of the famous physician and philosopher Hippocrates, treatment for many orthopaedic problems was rather basic. For example if you presented to Hippocrates clinic complaining that your shoulder seemed to fall out of place every time you threw your discus he may have decided to offer you the latest innovation in shoulder surgery – a red hot poker skillfully inserted into your armpit. This treatment as described in his writings caused a searing of the flesh, shrinking your ligaments and creating enough scar tissue to ensure that your shoulder never came out of the socket again. Surprisingly he reported great success with this procedure (It’s hard to imagine many would complain of failed treatment).

Yet as barbaric and unappealing as that treatment sounds it’s use continued with only minor variations (some design modifications were made to the pokers) for the next 1800 years.

Gradually medical science evolved and surgical techniques were developed allowing ligaments to be tightened by the use of sutures. From then until modern times this has been the predominant operative method and “gold standard” used to address joint instability problems. Although results are typically good these operations generally involve a considerable amount of tissue dissection (rearranging your anatomy) and the rehabilitation period is lengthy.

In the last 10 years the quest for a way to improve on this “gold standard” has stimulated orthopaedic surgeons to seek innovative technologies that would create a breakthrough in treatment. Thankfully we have been successful and the new technology is … a high tech hot poker! Now don’t get nervous no one is sticking hot pokers in armpits anymore. We are however using the same concept by using thermal energy to tighten up tissue.

In the early 1980’s basis science research demonstrated that heating type I collagen, which is the predominant collagen present within joint ligaments, causes a structural transformation within the collagen. Heat alters the helical structure of collagen producing a longitudinal shortening of the fibers.

The research also showed there is a narrow temperature window between optimal shrinkage of the collagen and irreversible damage.

The first devise used to heat ligaments was the HoYAG laser. Although capable of delivering a controlled amount of heat to the tissue the laser was very expensive, somewhat complicated to use, required special training and a special operating room. More recently a new devise has provided a simpler and more cost-effective method by expanding an existing technology. This devise uses radio frequency energy signals to heat the tip of a small probe. This probe can then be directed into a joint using arthroscopy to tighten the ligaments (arthroscopy uses a small optical tube that is attached to a camera and TV screen that can be inserted into joints via a very small incision).

The potential of this technology has led to a dramatic increase in its applications and utilization in sports medicine orthopaedics. With this procedure many shoulder, knee and ankle instability problems that would otherwise require more extensive surgery can now be dealt with using a minimally invasive approach, reducing surgery time and accelerating recovery time. My personal experience with this procedure has been very favorable and I have been very pleased with the results my patients have received. Although initially promising this is still a new treatment. Only time will tell what the long-term success rate will be for this procedure. When considering this treatment, discuss carefully the pros and cons with your surgeon to make sure this is right for you.

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