I am a former swimmer who gave up the sport because of shoulder pain. I was diagnosed with multi-directional instability of both shoulders. Physical therapy and strengthening exercise have not helped. I would like to avoid surgery with a large open incision, which has been suggested. Can arthroscopic surgery help my shoulders?

Multi-directional instability in both shoulders that is unresponsive to physical therapy and exercise is a formidable problem. Your shoulders are loose in several directions, which can lead to other problems such as injury to the rotator cuff tendon and joint cartilage. Only when non-operative treatment has failed is surgery considered. A standard open incision surgery for this problem has a history of mixed results depending on the degree of instability and the age of the patient at the time of surgery. Arthroscopic surgery using several 1/4-inch incisions have advanced to the point where the redundant capsule responsible for the instability can be reduced in size. It also can loosen, as can the conventional open surgery technique. However, arthroscopic surgery for shoulder instability is now being used in combination with laser probes and heat probes. Studies have found that shoulder capsules will shrink when treated with laser energy or with electrothermal energy. Preliminary results show that better results are attained when arthroscopic surgical techniques, used to stabilize the redundant joint capsule, are combined with arthroscopic capsular shrinkage using laser and heat probes. Not all cases of multidirectional instability are candidates for this combined arthroscopic procedure. A careful assessment of the degree of instability is needed to see if you are a candidate.