Shoulder Arthrodesis
Indications
- Active infection with destruction of joint surfaces
- Gunshot wounds
- Brachial plexus / nerve injuries (most common cause)
- Failed prosthesis
- Massive cuff tears
- Paralysis
-
Lesions of upper plexus
- stabilisation of shoulder to position hand for ADL
-
Complete plexus injuries
- AEA & arthrodesis of shoulder to enable use of prosthesis
-
If trapezius, levator scapulae & perhaps serratus anterior may be functioning
- improved movement of scapulo thoracic joint
Contraindications
-
Charcots Joint (usually 2o to syringomyelia)
-
Osteoarthritis & RA
-
AVN
Position
- Hand to mouth & ipsilateral trouser pocket
-
30° Abduction
-
30° Flexion
-
30° Internal rotation
Surgical Technique
- Patient on side, arm hand & shoulder prepared & free draped
- Incision just inferior to spine of scapula over acromion & across humeral head to insertion of deltoid
- Expose spine of scapula by releasing trapezius & deltoid
- Split deltoid down to its insertion
- Excise rotator cuff & capsule
- Remove remaining articular surface of humeral head & glenoid
- Remove subchondral glenoid bone & undersurface of acromion, osteotomise upper surface of humeral head & greater tuberosity parallel to acromion with arm in desired position
- Position hand close to patients mouth
- correct position for fusion
- Fix humeral head to glenoid using AO screws
- Mould DC Plate over spine of scapula, acromion & onto shaft of humerus & secure
- Position second plate posteriorly to control rotation from posterior aspect of spine to humeral head
- Outer 2.5cm of clavicle is excised if evidence of AC joint Osteoarthritis
- Wounds closed over drain & pillow positioned in axilla to support arm
- Sling after few days
- begin scapulo thoracic movement at about one week
Complications
- Prominence of plate & screws
-
Infection
-
Non Union
-
fracture of humerus below plate
-
Malposition of shoulder
-
Persistent pain in some patients
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