How is a Capsular Shift Procedure Performed?

The capsular shift can be performed using either open surgery or arthroscopy, with the latter being the more common approach due to its minimally invasive nature.

Procedure Steps:

1. Incision and Visualization:
   • In open surgery, a larger incision is made to access the shoulder joint.
   • In arthroscopic surgery, small incisions are used, and a camera (arthroscope) is inserted for visualization.
2. Capsule Tightening:
   • The joint capsule is shifted and tightened by folding and suturing the redundant tissue.
   • For anterior instability, the front of the capsule is tightened.
   • For posterior instability, the back of the capsule is adjusted.
3. Suture Placement:
   • Special anchors or sutures are used to secure the tightened capsule in place.
4. Closure:
   • The incisions are closed, and a dressing is applied.

Benefits of the Capsular Shift Procedure

• Improves Stability: Restores normal tension in the joint capsule, preventing excessive movement.
• Customizable: Can address instability in one or multiple directions.
• Minimally Invasive (arthroscopic approach): Results in less pain and faster recovery compared to open surgery.
• Long-Term Relief: Effective in preventing recurrent dislocations.

Recovery and Rehabilitation

Post-Surgery Recovery:

• Immobilization: The shoulder is immobilized in a sling for 4-6 weeks to protect the repair.
• Pain Management: Includes medications, ice therapy, and gradual activity.

Rehabilitation Phases:

1. Phase 1 (0-6 weeks):
   • Passive range-of-motion exercises.
   • Avoidance of active shoulder use.
2. Phase 2 (6-12 weeks):
   • Gradual introduction of active range-of-motion exercises.
   • Light strengthening exercises focused on the rotator cuff and scapular stabilizers.
3. Phase 3 (3-6 months):
   • Progressive strengthening and functional training.
   • Return to sports or strenuous activities typically after 6 months.

Risks and Complications

While capsular shift is generally safe, potential risks include:

• Stiffness: Reduced range of motion, particularly if rehabilitation is delayed.
• Recurrent Instability: A small risk of re-dislocation or instability.
• Over-tightening: Can lead to excessive stiffness or difficulty with certain movements.
• Infection or Nerve Injury: Rare complications at the surgical site.

Who is a Candidate for Capsular Shift?

The procedure is ideal for patients who:

• Have chronic shoulder instability without significant bony defects.
• Experience multidirectional instability or recurrent subluxations.
• Have failed conservative treatment, such as physical therapy.
• Engage in activities that require a stable shoulder, like overhead sports.

Success Rates and Outcomes

Capsular shift procedures have a high success rate, with studies showing:

• 85-95% improvement in stability and function.
• A return to pre-injury activity levels for most patients.

Outcomes depend on factors like:

• The direction and severity of instability.
• The type of surgery (open or arthroscopic).
• The patient’s adherence to rehabilitation.

Capsular Shift vs. Other Procedures

Procedure	Indication	Approach	Focus
Capsular Shift	Multidirectional instability	Tightens joint capsule	Soft-tissue stability
Bankart Repair	Labral tears from dislocation	Labral repair and stabilization	Glenoid soft-tissue repair
Latarjet Procedure	Bony defects, failed repairs	Bone graft and soft-tissue repair	Glenoid bony and soft-tissue repair

Conclusion

The capsular shift procedure is a highly effective treatment for addressing shoulder instability caused by a loose or redundant joint capsule. Whether performed arthroscopically or via open surgery, it offers long-term relief, improved shoulder function, and reduced dislocations for individuals with multidirectional instability or chronic looseness.