Our Summary

This research paper is about a last-resort procedure for serious shoulder problems called shoulder arthrodesis, which can help to stabilize the shoulder and reduce pain. It is commonly used in cases of severe shoulder injury, chronic instability, and when shoulder replacement surgery has failed. This procedure can be performed in several ways, using different kinds of fixation methods (like screws or plates) either inside or outside the joint. The best position for the arm during this procedure is a topic of much debate, but it’s generally thought to be 30° of flexion, 30° of abduction, and 30° of internal rotation. After successful surgery, patients should be able to perform basic tasks like bringing their hand to their mouth and reaching their back pocket. This procedure can have complications, including failed union, incorrect union, fracture, and infection. As shoulder replacement surgeries are becoming more common, so are cases where they fail, which could make this salvage procedure increasingly necessary.

FAQs

  1. What is shoulder arthrodesis and when is it considered?
  2. What are the different techniques used for joint fusion in shoulder arthrodesis?
  3. What are the possible complications after shoulder arthrodesis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about joint fusion is to follow post-operative rehabilitation and physical therapy protocols diligently to optimize function and recovery. It is important to work closely with your healthcare team to ensure proper healing and to achieve the best possible outcome after joint fusion surgery.

Suitable For

Patients who are typically recommended joint fusion include those with:

  1. Brachial plexus injury: Shoulder arthrodesis can provide stability and function in cases where there is severe nerve damage.

  2. Chronic instability with rotator cuff and deltoid dysfunction: In cases where the rotator cuff and deltoid muscles are no longer able to support the shoulder joint, fusion may be necessary to provide stability.

  3. Failed shoulder arthroplasty: In situations where a shoulder replacement has failed or is no longer viable, arthrodesis may be considered as a salvage procedure.

It is important to note that shoulder arthrodesis is a last resort procedure and is typically recommended when all other treatment options have been exhausted. The decision to undergo joint fusion should be made in consultation with a qualified orthopedic surgeon.

Timeline

Before joint fusion:

  1. Patient experiences chronic shoulder pain and instability.
  2. Patient undergoes various conservative treatments such as physical therapy, cortisone injections, and medications.
  3. Patient may undergo arthroscopic surgery or shoulder arthroplasty as a last resort.
  4. If these treatments are unsuccessful, patient may be considered for shoulder arthrodesis.

After joint fusion:

  1. Patient undergoes shoulder arthrodesis surgery to fuse the glenohumeral joint.
  2. Patient goes through a period of immobilization and rehabilitation to promote fusion.
  3. Patient gradually regains stability and function in the shoulder.
  4. Patient may experience improved pain relief and range of motion in the shoulder.
  5. Patient may need to adjust to limitations in shoulder movement and function.
  6. Patient may experience complications such as nonunion, malunion, fracture, or infection.
  7. Patient is able to perform basic daily activities with the fused shoulder.

What to Ask Your Doctor

  1. What is the reason for recommending joint fusion in my case?
  2. Are there any alternative treatments or procedures that could be considered before joint fusion?
  3. What are the potential risks and complications associated with joint fusion?
  4. How long is the recovery process after joint fusion surgery?
  5. Will I need physical therapy or rehabilitation after the surgery?
  6. What limitations in movement or function can I expect after joint fusion?
  7. How likely is it that the fusion will be successful in my case?
  8. Will I need any additional surgeries or treatments in the future after joint fusion?
  9. How soon after surgery can I expect to see improvements in my pain and mobility?
  10. What can I do to maximize the success of the joint fusion surgery and minimize the risk of complications?

Reference

Authors: Abboud JA, Cronin KJ. Journal: J Am Acad Orthop Surg. 2022 Aug 15;30(16):e1066-e1075. doi: 10.5435/JAAOS-D-21-00667. PMID: 36067462