{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:23:58Z","timestamp":1771806238724,"version":"3.50.1"},"reference-count":14,"publisher":"BMJ","issue":"23","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2023,5,29]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine the effect of arthroscopic capsular shift surgery on pain and functional impairment for people with atraumatic shoulder (glenohumeral) joint instability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a randomised, placebo-controlled clinical trial in a specialist secondary care facility. Patients aged 18 years and over who reported insecurity (apprehension) in their shoulder joint and had evidence of capsulolabral damage on arthroscopic examination were included. Patients were excluded if their shoulder apprehension symptoms were precipitated by a high velocity shoulder injury, they had bony or neural damage, a rotator cuff or labral tear, or previous surgery on the symptomatic shoulder. Sixty-eight participants were randomised and received diagnostic arthroscopy, followed by arthroscopic capsular shift or diagnostic arthroscopy alone. All participants received the same postoperative clinical care. The primary outcome was pain and functional impairment measured with the Western Ontario Shoulder Instability Index. The prespecified minimum clinically important effect was a reduction in pain and disability of 10.4 points.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean reductions in pain and functional impairment for both groups were similar. Compared with diagnostic arthroscopy, arthroscopic capsular shift increased pain and functional impairment by means of 5 points (95%\u2009CI \u22126 to 16 points) at 6 months, 1 point (95%\u2009CI \u221211 to 13 points) at 12 months and 2 points (95%\u2009CI \u221212 to 17 points) at 24 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Compared with diagnostic arthroscopy alone, arthroscopic capsular shift confers, at best, only minimal clinically important benefit in the medium term.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT01751490\">NCT01751490<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2022-106596","type":"journal-article","created":{"date-parts":[[2023,6,12]],"date-time":"2023-06-12T17:20:13Z","timestamp":1686590413000},"page":"1484-1489","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Arthroscopic capsular shift surgery in patients with atraumatic shoulder joint instability: a randomised, placebo-controlled trial"],"prefix":"10.1136","volume":"57","clinical-trial-number":[{"clinical-trial-number":"nct01751490","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct01751490","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Anju","family":"Jaggi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert D","family":"Herbert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Alexander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Addie","family":"Majed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Butt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Higgs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Will","family":"Rudge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5023-9592","authenticated-orcid":false,"given":"Karen A","family":"Ginn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,6,12]]},"reference":[{"key":"2024051423012641000_57.23.1484.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cuor.2004.04.002"},{"key":"2024051423012641000_57.23.1484.2","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1177\/1758573215585656","article-title":"BESS\/BOA patient care pathways: traumatic anterior shoulder instability","volume":"7","author":"Brownson","year":"2015","journal-title":"Shoulder Elbow"},{"key":"2024051423012641000_57.23.1484.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1058-2746(98)90050-7"},{"key":"2024051423012641000_57.23.1484.4","doi-asserted-by":"publisher","DOI":"10.1007\/BF00932317"},{"key":"2024051423012641000_57.23.1484.5","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1177\/1758573218815002","article-title":"BESS\/BOA patient care pathways: Atraumatic shoulder instability","volume":"11","author":"Noorani","year":"2019","journal-title":"Shoulder Elbow"},{"key":"2024051423012641000_57.23.1484.6","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1302\/0301-620X.102B12.BJJ-2020-0296.R1","article-title":"Recurrent posterior shoulder instability starting in childhood and Adolecsence","volume":"102-B","author":"Langlais","year":"2020","journal-title":"Bone Joint J"},{"key":"2024051423012641000_57.23.1484.7","first-page":"1171","article-title":"Joint Orthoapedic initiative for national trials of the shoulder - Canada","volume":"23","author":"Mohadi","year":"2014","journal-title":"J Shoulder Elbow Surg"},{"key":"2024051423012641000_57.23.1484.8","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1016\/j.arthro.2011.12.006","article-title":"Open Capsular shift and Arthroscopic Capsular plication for treatment of Multidirectional instability","volume":"28","author":"Jacobson","year":"2012","journal-title":"Arthroscopy"},{"key":"2024051423012641000_57.23.1484.9","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1186\/1471-2474-15-439","article-title":"Does surgery followed by Physiotherapy improve short and long term outcomes for patients with Atraumatic shoulder instability compared with Physiotherapy alone? 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