Arthrodesis (Shoulder Fusion)

Overview
Reviewed by Dr. Jon Warner

(Also known as Shoulder Fusion)

Arthrodesis, from the words "arthro," or joint, and "desis," or binding, means a surgical fusion of the upper arm bone to the shoulder socket. It is often prescribed for patients with severe osteoarthritis, rheumatoid arthritis, or paralysis of the shoulder, especially as the result of polio. In a glenohumeral fusion, the upper arm bone, or humerus, is affixed to the end of the shoulder blade, or glenoid, which forms the shoulder socket, as well as the acromion, which forms the roof of bone above the head of the humerus.

Detailed Description
Specialist

Orthopedic surgeon

Procedure

Before the Procedure:

Since an arthrodesis severely limits the patient's range of motion, the surgeon will examine the patient to determine the most appropriate range of motion the arm should have after the surgery. For example, a patient in a wheelchair must have enough range of motion to push the wheels of the chair, while other patients may need the ability to drive.

The patient is dressed in a hospital gown and is anesthetized both by general anesthesia and nerve block, numbing the nerves to the shoulder and arm that come out of the neck. The area around the joint is cleansed to ensure sterility.

During the Procedure:

A surgeon performing arthrodesis aims to give the two bones the strength and stability of one bone. To do this, the surgeon makes a long incision in the skin on the back of the shoulder and cuts through part of the deltoid muscle to gain access to the joint. Any stray tissue within the joint is debrided. The surgeon then affixes two or more screws, and may use a metal plate as well, to affix the humerus deep into the glenoid. Usually the shoulder is positioned so that the hand can reach the mouth as well as the side pocket or hip area once the fusion is solid. The incision is then stitched together.

Recovery

Recovery from an arthrodesis is often a painful process; the patient must adapt to his or her new limitations. For patients whose arms are affixed in a downward position, brushing the hair or teeth, applying make-up, and washing the face will be impossible, and may require an aid's assistance. For patients with upwardly-fixed arms, dressing oneself, buckling a belt, or tying the shoes will not be possible. A structured rehabilitation program designed by a doctor or physical therapist will maximize mobility and outlook.

Complications/Risks

• Loosening of surgical fixation
• Misplacement of arms
• Surgical wound infection

Medications

Prescription pain relievers and anti-inflammatory drugs, possible antibiotics to prevent infection or rejection.

Follow up with your doctor if:

Pain, swelling, redness, drainage or bleeding increases around the shoulder joint or there are symptoms suggesting infection such as fever.

Last updated: 01-Jan-00