Updated: 10/6/2016

Shoulder Arthrodesis

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Topic
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Questions
2 2
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Evidence
3 3
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Introduction
  • The goal of shoulder arthrodesis is to provide a stable base for the upper extremity optimizing hand and elbow function
    • it remains an important treatment option in appropriately selected patients
  • Indications
    • stabilization of paralytic disorders
    • brachial plexus palsy
    • irreparable deltoid and rotator cuff deficiency with arthropathy
    • salvage of a failed total shoulder arthroplasty
    • reconstruction after tumor resection
    • painful ankylosis after chronic infection
    • recurrent shoulder instability which has failed previous repair attempts
    • paralytic disorders in infancy
  • Contraindications
    • ipsilateral elbow arthrodesis
    • contralateral shoulder arthrodesis
    • lack of functional scapulothoracic motion
    • trapezius, levator scapulae, or serratus anterior paralysis
    • Charcot arthropathy during acute inflammatory stage (Eichenholtz 0-2)
    • elderly patients
    • progressive neurologic disease
Anatomy
  • Glenohumeral articulation
    • a relatively small amount of surface area exists allowing for predictable fusion
    • to increase the available fusion area, decortication of both the glenohumeral articular surface and the articulation between the humeral head and the undersurface of the acromion is performed
    • only the glenoid fossa and base of the coracoid provide sufficient strength for fixation
Presentation
  • Symptoms
    • specific to the underlying condition necessitating arthrodesis
    • symptomatic dysfunction of the glenohumeral joint
Imaging
  • Radiographs
    • recommended views
      • AP, lateral, and axillary views to assess bone stock available for fusion and deformities
  • CT
    • better to evaluate glenoid bone loss especially in the setting of failed arthroplasty
Studies
  • EMG
    • indicated when the neurologic condition of the scapular muscles is ill-defined
Surgical Technique
  • Approach
    • S-shaped skin incision beginning over the scapular spine, traversing anteriorly over the acromion, and extending down the anterolateral aspect of the arm
  • Fusion position
    • goal is to allow patients to reach their mouths for feeding 
      • think "30°-30°-30°" 
        • 20°-30° of abduction
        • 20°-30° of forward flexion
        • 20°-30° of internal rotation
  • Technique
    • rotator cuff is resected from the proximal humerus and the biceps tendon is tenodesed
    • glenoid and humeral head articular surfaces and the undersurface of the acromion are decorticated
    • arm is placed into the position of fusion (30°-30°-30°)
    • a 10-hole, 4.5 mm pelvic reconstruction plate is contoured along the spine of the scapula, over the acromion, and down the shaft of the humerus
    • compression screws are placed through the plate across the glenohumeral articular surface into the glenoid fossa
    • the plate is anchored to the scapular spine with a screw into the base of the coracoid
  • Postoperative care
    • a thermoplastic orthosis is applied the day after surgery and is maintained for 6 weeks
    • at 6 weeks, may transition to a sling if there are no radiographic signs of loosening
    • at 3 months, mobilization exercises and thoracoscapular strengthening are commenced if no radiographic signs of loosening are present
    • expected recovery period is 6-12 months
Complications
  • Infection
  • Nonunion
  • Malposition
  • Prominent hardware
  • Humeral shaft fracture
 

Please rate topic.

Average 4.2 of 22 Ratings

Questions (2)

(OBQ11.69) Which of the following patients would benefit most from a glenohumeral arthrodesis? Tested Concept

QID: 3492
1

A 74-year-old man with AVN of the proximal humerus

1%

(46/3267)

2

A 24-year-old woman with recurrent instability after an arthroscopic procedure for multi-directional instability

1%

(21/3267)

3

A 30-year-old laborer with a paralysis of the deltoid and rotator cuff muscles

88%

(2860/3267)

4

A 70-year-old patient with removal of an infected primary total shoulder arthroplasty

8%

(248/3267)

5

A 20-year-old man patient with cleidocranial dysostosis

2%

(75/3267)

L 1 C

Select Answer to see Preferred Response

(OBQ06.241) A 45-year-old man has paralysis of his deltoid and rotator cuff as the result of a motorcycle injury. His neurologic injury has not improved in the 5 years since the injury, but he does have some use of his hand and wrist. What is the most appropriate treatment? Tested Concept

QID: 252
1

Levator scapulae and rhomboid tendon transfer

11%

(145/1338)

2

Total shoulder replacement

0%

(6/1338)

3

Reverse total shoulder replacement

1%

(17/1338)

4

Shoulder arthrodesis

55%

(736/1338)

5

Latissimus dorsi transfer

32%

(430/1338)

L 2 D

Select Answer to see Preferred Response

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Topic COMMENTS (6)
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