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Techniques in Shoulder and Elbow Surgery:
September 2008 - Volume 9 - Issue 3 - pp 151-163
doi: 10.1097/BTE.0b013e3181816107
Techniques

A Humeral-Sided, Subscapularis-Splitting Capsulorrhaphy Procedure for Multidirectional Shoulder Instability

Humphrey, C. Scott MD; Giangarra, Charles E. MD

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Abstract

The humeral-sided, subscapularis-splitting capsulorrhaphy (HSSSC) procedure is a modification of Neer and Foster's inferior capsular shift surgical technique for treating multidirectional shoulder instability. As it is currently described in the literature, when a humeral-sided capsulorrhaphy is performed, access to the capsule is gained by incising the subscapularis tendon near its insertion into the humerus. Our approach to capsular reconstruction differs in that it preserves the subscapularis tendon insertion by combining a subscapularis muscle-splitting approach with a humeral-sided T-plasty. To our knowledge, combining these 2 techniques has not been previously described. We report the clinical results at 39-month average follow-up for 5 female overhead athletes who underwent HSSSC by the senior author (C.E.G.). A theoretical argument for performing capsular reconstruction in this manner is also presented. In our small series, HSSSC resulted in excellent shoulder stability, excellent patient satisfaction, and restoration of a high level of athletic performance. We believe that our approach will better preserve subscapularis function, but further studies are necessary to prove this and to compare the results of this procedure with other shoulder-stabilizing techniques.

© 2008 Lippincott Williams & Wilkins, Inc.

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