Is a shoulder fusion reversible?

[mtomaino]

I received an email recently via the "Contact Dr Tomaino" section of www.drtomaino.com, and wanted to respond:

Hi Dr. I had my shoulder fused after a total shoulder replacement didnt work. Is there a procedure to undo a fused shoulder? Thank you,

Although joint fusions can be "taken down", this is an unusual indication typically. When fusions are reversed in the upper extremity, it usually means that some kind of motion-restoring arthroplasty is desired. This has been successfully performed in cases of elbow fusion, wrist fusion and finger joint fusion---but I have no personal knowlege of shoulder fusion being reversed.

Though it is probably technically possible, the a fused shoulder is typically capable of some useful shoulder motion because of the functioning joint between the scapula and the thorax. In contrast, a fused wrist and elbow are incapable of motion, although the former is a common operation because the absence of wrist flexion and extension does not completely restrict hand function.

In the setting of a failed shoulder replacement (and the causes may have been instability, infection or nerve injury), shoulder fusion is, in many cases, the "salvage." With the development of the Reverse shoulder, one might argue that forward elevation to 90 degrees or possibly more, would be attainable with only a functioning deltoid muscle. But--capsular restriction, and the absence of functioning rotator cuff would likely result in a poor outcome if this type of arthroplasty was performed after a fusion. Further, rotation would probably not be restored.

In short, the answer to this query, in general is No. Although there may exist a very uncommon role for Reverse shoulder arthroplasty as a way to restore shoulder motion when function is not satisfactory following a fusion, it would be essential that the deltoid muscle and scapulothoracic joint are functioning. If this is the case--there would likely be little functional gain by taking down the fusion, and the risk of complications would be very high.