When spontaneous recovery of the deltoid and rotator cuff muscles does not occur, procedures such as neurolysis, nerve grafting, and muscle transfer may be warranted in an effort to reestablish shoulder function. But, if too much time has elapsed, if you are older than 45-50, or if alternative procedures are not an option, Shoulder arthrodesis may a feasible way to restore some ability to position your arm and hand. Because the trapezius and levator scapulae muscles are almost always intact after traumatic brachial plexus injury, active arm abduction can occur through the scapulothoracic articulation. When the serratus anterior is preserved, forward elevation of the arm through scapular rotation is also possible. Shoulder arthrodesis is not possible, however, if functional scapulothoracic motion is absent, which may be caused by paralysis of the trapezius, levator scapulae, and serratus anterior muscles.
The ideal position for shoulder arthrodesis remains a matter of debate. Most surgeons agree that the proper position of shoulder arthrodesis should enable the patient to reach the face for washing, the midline for dressing and hygiene, and the back pocket. Fusion of the shoulder joint in 20° of abduction, 20° of forward flexion, and 20-40° of internal rotation usually allows acceptable function. A 4.5-mm pelvic reconstruction plate is contoured to accommodate the spine of the scapula, the lateral surface of the acromion, and the lateral portion of the proximal humerus.
Functional outcome after shoulder arthrodesis has lagged behind pain improvement, but most patients (except those with distal extremity paralysis or amputees) can easily get their hand to reach the mouth. Many can touch their head, and wash their hair, but performing overhead work is usually not possible. Among the complications of shoulder arthrodesis are nonunion, malpositioning of the fused shoulder, perifusion fractures, infection, continued pain, and soft-tissue irritation caused by prominent fixation devices. The frequency of these complications is related to the quality and quantity of bone available for fusion as well as to the condition of the soft-tissue envelope.
A solid fusion achieves good pain relief and acceptable ADL (activities of daily living) function in most patients. 6-8 weeks in a chest-shoulder orthosis and/or sling is mandatory after surgery.
