Applications in the following shoulder conditions
- Frozen shoulder or adhesive capsulitis
- Instability either subluxations or dislocations
- Impingement syndrome
- Rotator cuff tears
The LASER can be used in the above conditions to:
- Debride labral tears
- Perform synovectomy (remove joint lining)
- Chondral debridement, cuff smoothing
- Release soft tissues ie. capsulecontracture/adhesions
- Subacromial decompression removing - bursa-ligament -periosteum -bone
- "LACS" -Laser Assisted CapsularShrinkage for shoulder instability
with the advantage of minimal bleeding (good visualisation) throughout the procedure
Arthroscopic Laser Subacromial Decompression
Removing thickened bursal tissue, coracoacromial ligament and bone spurs can be accomplished by mechanical debriders and burrs in conjunction with electrodiathermy to burn the bleeding blood vessels or high pressure fluid distention to compress the vessels, or by use of Laser energy which will cut and sculpture the tissues while sealing the vessels at the same time. The need to keep changing instruments and distend the tissues with high volumes of fluid are therefore avoided and this may be the reason that pain experienced by patients treated with the Laser is reportedly less.
Since no major structures are damaged during this procedure immediate movement and rehabilitation is encouraged.
- Hourly range of movement is begun in the recovery room and aided throughout the first 24 hours. Since there are no drainage tubes necessary and minimal swelling this does not cause a lot of pain and minimises adhesion formation.
- Ice is applied each hour after the exercises.
- As pain is less when performed with the LASER, some patients may do this at home with the help of their partner, some elect to stay overnight in hospital and are helped by the nurses.
- Most patients are able to return to light duties by 3 weeks, some after a few days depending on what is available. Driving is quite comfortable by 3 weeks.
- No heavy lifting or overhead work until 3 months after the operation.
- Most sports can be resumed at 3 months.
Study by Andreas Imhoff
Arthroscopy, Vol. 11, No 5 (October), 1995: pg. 549-556
"Because of the low level of postoperative pain, the absence of adhesions and the almost complete lack of swelling, the patients in group L (laser), were able to regain full range of shoulder motion sooner than those in group S (without laser)"
"The postoperative Constant score for group L was significantly better." (54.7-79.8 vs. 50.3 - 68.7)
"The greatest improvement in the laser group was seen in the area of pain with activity, pain at night, activity and movement at 1 week and at 6 weeks"
Study in Adelaide 1997
Thirty four patients were followed throughout there hospitalisation and for the following 6 weeks to assess the pain levels they experienced during their episode of treatment . Visual analog scales(VAS) were recorded at 1,2,3,6,12,18 hours after surgery and again 3 & 6 weeks after discharge and the pain scores compared for those who had the advantage of the LASER and those who didn't. The following graph represents the results demonstrating that with the use of the LASER pain was reduced by 50% while in hospital and by in 66% in the early rehabilitating period allowing earlier return of function(ie. return to work).
We believe that the reduction in pain experienced with the LASER decompressions may be explained by the fact that there is much less bleeding therefore there is no need to distend all the tissues with pressurised fluid to stop blood from clouding vision in the operating field. Swelling of the shoulder is markedly less after surgery and therefore nerve endings less irritated.
In addition no drainage tubes are necessary (as there is no bleeding) and so immediate movement of the joint in hospital is much less painful - allowing for physiotherapy to start in the recovery room after surgery, full movement being easier to achieve before discharge.
Because the anaesthetic is shorter (reduced operating time) and less pain relief (narcotics) are needed the patients in general do not feel so unwell and have more pleasant memories of the episode of treatment, many coming back early for treatment of their other shoulder.
LACS - Laser Assisted Capsular Shrinkage for Shoulder Instability
LASER energy can be used to shrink collagen tissue such as found in the capsule and ligaments of the shoulder joint.
Instability of the shoulder joint may be either dislocations, subluxations or minor laxity problems which lead to "dead arm" episodes and dynamic impingement (pinching pains and aching in the younger patient). All these forms may benefit from the application of laser to stabilise the joint with minimal interference, pain and quick rehabilitation.
Following the success of Laser in this specific field other forms of energy are being trialled and found to be effective also (Radiofrequency).