Shoulder Arthrodesis (Fusion)

Q1. What is shoulder arthrodesis (shoulder fusion)?

Shoulder arthrodesis, or shoulder fusion, is a surgical procedure that permanently joins the two main bones of the shoulder joint: the head of the upper arm bone (humerus) and the shoulder blade (scapula). By fusing these bones together, they grow into a single, solid bone. This eliminates movement within the shoulder joint itself, which relieves severe pain and provides a stable platform for the arm.

Q2. Why is a shoulder fusion performed?

A shoulder fusion is typically performed as a reconstructive or salvage procedure when other treatments, including joint replacement, are not possible or have failed. The main reasons include:

• Severe, chronic joint infections that prevent joint replacement.
• Severe paralysis or nerve injury (such as a brachial plexus injury) causing a flail shoulder.
• Massive, irreparable rotator cuff tears with severe arthritis (cuff tear arthropathy) when reverse shoulder replacement is not an option.
• Chronic, uncontrollable shoulder instability or dislocation.
• Failed previous shoulder replacements where there is insufficient bone remaining to perform another replacement.

Q3. Who is a candidate for shoulder arthrodesis?

Candidates for shoulder fusion are individuals who suffer from severe shoulder dysfunction and pain that cannot be managed by other means. A suitable candidate must:

• Have a functioning elbow, wrist, and hand to maximize arm utility after fusion.
• Have strong shoulder blade muscles (scapular stabilizers), as these muscles will control the movement of the fused arm.
• Be willing and able to participate in a lengthy recovery and rehabilitation process.

Q4. How does shoulder fusion affect shoulder movement and mobility?

After a shoulder fusion, you will no longer be able to move your arm at the main shoulder joint. However, you will still be able to move your arm by rotating and tilting your shoulder blade (scapula) against your rib cage. You can expect to:

• Lift your arm forward and to the side to a limited degree (usually up to 60-90 degrees).
• Bring your hand to your mouth, face, and head, provided your elbow and hand function normally.
• Reach your front pockets and perform most basic daily grooming activities.
• Have difficulty reaching behind your back, reaching your opposite shoulder, or raising your arm fully overhead.

Q5. How is a shoulder arthrodesis surgery performed?

During this open surgery, the orthopedic surgeon:

• Makes an incision over the top and side of the shoulder.
• Removes any remaining cartilage from the socket (glenoid) and the humeral head to expose the healthy bone beneath.
• Positions the upper arm bone against the shoulder blade at a specific angle that optimizes hand function.
• Secures the bones together using a strong metal plate and screws.
• May use bone graft (from your body or a donor) to help stimulate bone growth and fusion across the joint.

Q6. What are the main benefits of having a shoulder fusion?

The primary benefits of a shoulder fusion include:

• Pain Relief: Eliminating movement in a damaged, arthritic joint provides reliable and significant pain relief.
• Joint Stability: The surgery eliminates chronic shoulder dislocations or instability.
• Improved Hand/Arm Function: A stable shoulder provides a solid foundation, allowing you to use your elbow, wrist, and hand more effectively.
• Durability: Unlike joint replacements, which can wear out over time, a successful fusion is permanent and highly durable.

Q7. What are the risks and potential complications of shoulder arthrodesis?

As with any major surgery, there are risks, which include:

• Nonunion: The bones may fail to fuse together, which may require a revision surgery.
• Infection: Surgical site or deep joint infection.
• Hardware Irritation: The metal plate or screws may become prominent or cause pain, sometimes requiring removal after the bone is fully fused.
• Fracture: Increased stress on the bone just below the metal plate can make it more susceptible to a fracture from a fall.
• Persistent Pain: While pain is usually greatly reduced, some patients may still experience mild discomfort or muscle fatigue.

Q8. How should I prepare for my upcoming shoulder fusion surgery?

To prepare for your surgery:

• Follow all pre-operative fasting and medication guidelines.
• Arrange for a family member or friend to drive you home and help you around the house for the first few weeks.
• Prepare your home by placing frequently used items at waist height to avoid reaching.
• Buy slip-on shoes and loose-fitting, front-zippered or button-up shirts that are easy to put on over a bulky dressing and sling.

Q9. What type of anesthesia is used during this procedure?

Shoulder fusion is performed under general anesthesia, which keeps you asleep and pain-free during the entire operation. In addition, your anesthesiologist may perform an interscalene nerve block. This is an injection of local anesthetic near the nerves in your neck that numbs your shoulder and arm, providing excellent pain relief for 12 to 24 hours after surgery.

Q10. Will I need to wear a sling or cast after surgery, and for how long?

Yes, protecting the shoulder is crucial to allow the bones to fuse. You will need to wear a specialized shoulder immobilizer, sling, or occasionally a shoulder spica cast. This must be worn at all times (including during sleep) for about 6 to 12 weeks. You should only remove it under the direct guidance of your surgeon, typically only for showering or dressing.

Q11. How can I manage my pain after shoulder fusion surgery?

Managing pain after surgery involves a combination of methods:

• Prescription Pain Medication: Take your prescribed medications exactly as directed, especially during the first few days.
• Ice Therapy: Apply ice packs wrapped in a thin towel to your shoulder for 15 to 20 minutes several times a day to reduce swelling and pain.
• Elevation: Keep your upper body elevated with pillows or sleep in a recliner chair to help reduce swelling.

Q12. What is the safest way to sleep after a shoulder arthrodesis?

Sleeping can be difficult while wearing a shoulder immobilizer. Safe sleeping positions include:

• Semi-Reclined Position: Sleeping in a recliner chair or propped up at a 45-degree angle in bed with pillows is usually the most comfortable.
• Supporting the Arm: If sleeping on your back, place a pillow under the elbow and forearm of your surgical arm to keep it from falling backward and putting tension on the shoulder.
• Do not sleep on your side or stomach under any circumstances during the recovery period.

Q13. What does the physical therapy and rehabilitation process look like?

Rehabilitation after shoulder fusion is gradual and focuses on protecting the fusion while maintaining hand and elbow function:

• Early Phase (Weeks 1 to 6): You will perform gentle exercises for your fingers, wrist, and elbow to prevent stiffness, but your shoulder will remain completely immobilized.
• Intermediate Phase (Weeks 6 to 12): Once early healing is confirmed, you may begin very gentle active movement of the shoulder blade (scapular motion) under the guidance of a physical therapist.
• Late Phase (Month 3 and beyond): As the fusion becomes solid on X-rays, you will progress to strengthening the muscles around your shoulder blade and upper back to maximize your arm's mobility.

Q14. How long does it take for the shoulder fusion to heal completely?

It typically takes 3 to 4 months for the humerus and scapula to fuse together solidly. Your surgeon will monitor this healing process with X-rays. Full recovery, including adapting to the new way your arm moves and rebuilding muscle strength, can take 6 to 12 months.

Q15. When can I return to daily activities, driving, and work?

Recovery timelines vary, but general guidelines include:

• Light daily activities: Writing, typing, or eating can begin within a few weeks, keeping your elbow supported and close to your side.
• Driving: You cannot drive while wearing the shoulder immobilizer or taking prescription pain medications, which typically means waiting at least 8 to 12 weeks.
• Work: If you have a sedentary or desk job, you may return in 4 to 6 weeks. If your job involves physical labor or lifting, you may need to wait 6 months or longer.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.