Shoulder arthrodesis




Indications have narrowed due to the success of shoulder arthroplasty


1. Chronic infection

2. Obstetric brachial plexus injury

3. Post-traumatic brachial plexus injury

4. Salvage of failed GHJ arthroplasty

5. Arthritic diseases unsuitable for arthroplasty / young patient

6. Tumour resection

7. Instability in epilepsy patients / severe MDI




Ipsilateral elbow fusion

Contralateral shoulder arthrodesis

Paralysis of scapula-stabilisers - necessary for function following arthrodesis

Charcot arthropathy (low chance union)




Permanent solution




Loss of movement at shoulder


Difficulty with activities

- at head level or behind the back 

- perineal care




1.  Hand should reach

- mouth

- waist

- belt buckle

- back pocket


2.  Shoulder be comfortable at rest / scapula should not be prominent

- arm should hang by side with scapula flat against thorax

- no winging





- abduction 10-15°

- flexion 10-15°

- internal rotation 45°



1.  Technically difficult to obtain correct position intra-operatively

2.  Internal rotation most important to later function

3.  Position in reference to trunk not scapula

4.  Avoid excessive abduction & flexion

- forces the scapula to rotate & wing at rest

- leads to fatigue & discomfort





- glenohumeral compression screws +/- acromiohumeral screws



- plate along spine of scapula / acromion and lateral humerus




Open Technique


Shoulder arthrodesis APShoulder arthrodesis lateral




Midline incision over spine / acromion /  down to deltoid tuberosity


A.  Posterior

- detach deltoid from spine

- between IS and TM


B.  Anterior

- detach deltoid from clavicle


C.  Identify and protect axillary nerve


D.  Excise rotator cuff tendon






1. Denude GHJ cartilage

2. Denude superior humeral head and undersurface acromion

3. Temporarily fix with steinman pins GHJ and acromio-humeral

- check position / ROM / no winging

4. Insert GHJ and acromial-humeral compression screws

5.  Supplement with pelvic reconstruction plate

- 12 - 14 hole

- scapular spine / acromion / humerus

6.  Bone graft

7.  Careful deltoid repair in case of future conversion to reverse TSR

8.  Spica / shoulder abduction sling


Arthroscopic Technique


Arthroscopy Technique








Fracture of humerus below fusion


Prominent hardware




Brachial plexus injury


Atlan et al. J Hand Surg Am 2012

- 54 patients with brachial plexus palsy

- fusion rate 76% after one procedure

- 94% after second operation

- abduction 45 degrees in 75% patients

- rotation 45 degrees in 65% patients




Thangarajah et al. J Bone Joint 2014

- 6 patients with epilepsy and chronic instability

- all cases achieved union and prevented instability


Failed total shoulder replacement


Scalise et al JBJS Am 2008

- 7 patients

- 4/7 required additional procedures to obtain union

- 2/7 persistent non-union

- extremely challenging


Conversion to Reverse TSR


Alta et al. JSES 2016

- takedown of 4 patients with scapula pain

- EMG evidence of deltoid function

- some improvements in pain and ROM