Katz, S, McGuire, P, Cowing, J; coastalorthopt@yahoo.com.

PURPOSE: This case report describes the management of two patients following arthroscopic Bankart repair and thermal assisted capsular shrinkage (TACS) of the glenohumeral joint (GHJ), including descriptions of pre- and post-surgical physical therapy interventions and outcome measures of range of motion (ROM), Biodex strength testing, and Shoulder Pain and Disability Index (SPADI) scores taken at regular intervals during, and following discharge from, physical therapy. SUBJECTS: Patient A was a 25-year old male construction worker with a medical diagnosis of recurrent left anterior GHJ instability and anterior labral tear. Patient A completed 17 physical therapy sessions between the 4^th and 12^th post-operative week. Patient B was a 22-year old male student with a medical diagnosis of left multi-directional instability and anterior labral tear. Patient B completed 6 post-operative physical therapy sessions during his first 8 post-operative weeks. The same orthopedic surgeon performed the surgery for both patients, however, each patient was treated by a different physical therapist at the same orthopedic clinic. METHODS/ANALYSES: Not Applicable. RESULTS: Patient A SPADI scores at 4, 12, 16, 24, and 28 weeks post-operatively were 171/1300, 0/1300, 0/1300, 83/1300, and 85/1300 respectively. Biodex strength testing for Patient A at 9 weeks post-operatively demonstrated the greatest deficit with external rotation, with the deficit ranging from 29-33%, and similarly demonstrated a 25% deficit with external rotation when tested at 16 weeks post-operatively. ROM measures reached a maximum of left shoulder internal rotation abducted (IRA) 99°, external rotation abducted (ERA) 95°, flexion 185°, and abduction 185°at 16 weeks post-operatively and did not show a significant increase thereafter. Patient B SPADI scores pre-operatively, at 4 and 9 weeks post-operatively were 368/1300, 538/1300, and 379/1300 respectively. Biodex strength testing at 9 weeks post-operatively demonstrated the most significant deficit with external rotation, ranging from 19-23%. At 9 weeks post-operatively Patient B demonstrated ROM measures of left shoulder IRA 60°, ERA 70°, flexion 178°, and abduction 165°. Both patients will continue to be followed to collect further data. CONCLUSIONS: Research evaluating the outcomes of arthroscopic TACS has indicated that this technique yields results similar to open procedures for some patient populations, including individuals with unidirectional instability either alone or in combination with capsolabral repair. Proper rehabilitation following surgery to facilitate dynamic stability of the shoulder complex is critical to the success of this procedure. However, additional research is needed to describe and evaluate the effectiveness of specific physical therapy interventions and to further define pre and post-operative characteristics of patients with positive outcomes. FUNDING: None.

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