Posterior instability of the shoulder following thermal capsulorrhaphy for multidirectional instability

Patients with multidirectional instability (MDI) of the shoulder can be treated with arthroscopic thermal capsulorrhaphy. However, recent literature suggests that complications and failures associated with this technique are on the rise. We present the case of a 30-year-old female patient who was treated for a failed thermal capsulorrhaphy. She had undergone this treatment of her left shoulder for MDI but had persistent pain with overhead activities and clicking in the posterior shoulder. Her history and physical examination were consistent with persistent posterior unidirectional instability of the shoulder. Magnetic resonance imaging showed a possible separation of the capsule from the posterior glenoid. After conservative management had been attempted several times, an arthroscopic repair was performed. At surgery, the anterior and inferior capsule appeared to be tight. However, the posterior capsule was extremely lax and patulous, but intact. A posterior capsule plication was performed arthroscopically, along with a rotator interval closure. Postoperatively, the patient was maintained in a sling that kept the arm in neutral rotation. At 6 weeks, the sling was removed, and a slow, progressive program of therapy was initiated. Stress on the posterior capsule was not permitted for 3 months. At 1-year follow-up, the patient had full pain-free range of motion and returned to participation in sports without limitation.