Joseph A. Abboud, MD; Kevin J. Cronin, MD

Disclosures

J Am Acad Orthop Surg. 2022;30(16):e1066-e1075. 

In This Article

Abstract and Introduction

Abstract

Shoulder arthrodesis is an end-stage, salvage procedure for the glenohumeral joint and can provide a pain-free, stable shoulder with varying levels of function. Common indications include brachial plexus injury, chronic instability with rotator cuff and deltoid dysfunction, and failed shoulder arthroplasty. Multiple techniques are described, including intra-articular and extra-articular arthrodeses. Fusion can be accomplished with screw fixation, plate fixation, external fixation, and arthroscopic-assisted techniques. The optimal position of the arm is heavily debated in the literature, but the ideal position is thought to be 30° of flexion, 30° of abduction, and 30° of internal rotation. After successful fusion, the patient should be able to bring their hand to their mouth, reach their back pocket, and cross the midline for hygiene. Complications are not uncommon and include nonunion, malunion, fracture, and infection. With the increasing incidence of shoulder arthroplasty, failed arthroplasties are more commonly encountered. In a salvage situation, shoulder arthrodesis may be considered.

Introduction

Shoulder arthrodesis involves fusion of the humeral head to the glenoid and is mostly used as an end-stage, salvage procedure.[1] The first reports of shoulder arthrodesis were from the early 20th century, and indications included notable proximal humeral bone loss from tuberculosis and flail extremity due to poliomyelitis.[2,3] Over time, indications evolved to include primary or inflammatory arthritis of the glenohumeral joint, deltoid dysfunction, and massive, irreparable rotator cuff tears, resulting in pseudoparalysis. Improvements and widespread adoption of shoulder arthroplasty for these historical indications has markedly limited the current utility for primary shoulder arthrodesis.[4] However, shoulder arthrodesis may be considered as an option in those with brachial plexopathy, chronic instability with rotator cuff and deltoid dysfunction, bone loss after tumor resection, and failed shoulder arthroplasty. In these unique situations, arthrodesis can provide a pain-free shoulder that is stable and retains some level of function.[5]

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