Thermal capsulorrhaphy for instability of the shoulder: concerns and applications of the heat probe.

The use of the heat probe, in my experience, is another instrument to address shoulder instability; however, it will probably not replace suture repairs. Sutures may be used to (1) reattach soft tissue to bone, (2) repair capsule tears lateral to the glenoid, (3) close intervals including the rotator capsular interval, and (4) provide internal fixation to thermally treated tissue. Surgeons need to be able to perform suture repairs to plicate tissues that do not have significant response during the heat application. Most capsular volume reduction procedures require some form of capsular inflammation to stimulate a healing process. The heat probe can be used in a manner similar to the rasp. Sutures will provide internal fixation during the long reparative and remodeling phases. Greater knowledge is necessary regarding techniques, postoperative management, limitation of the procedures, and long-term outcomes. Improvements in application will hopefully reduce complications. Abuse of the heat probe by the inexperienced places its popularity in jeopardy. Following the experts' advice, remaining current in the literature, and improving techniques at laboratory courses will offer the best results to patients.