SCAPULOHUMERAL ARTHRODESIS FOR NON-NEUROLOGICAL SHOULDER: STATE-OF-THE-ART IN 2003

Abstract

Purpose: Scapulohumeral arthrodesis is principally indicated for plexus brachial paralysis. It is a controversial indication with limited use for non-neurological conditions. We report a series of shoulder arthrodeses performed for non-neurological conditions searching for the appropriate indications for this procedure.

Material and methods: The series included nine patients, six men and three women, mean age 48 years (23–89). The dominant side was fused in three and the non-dominant in six. Seven patients had had at least one operation prior to arthrodesis. The procedure was performed in one patient to remove a foreign body in a prosthetic cuff tendon, in three for off-centred joint degeneration with massive cuff tears and in two for degenerative disease with multidirectional instability. In all patients except one, the posterior approach was used for internal screw fixation associated with external fixation (left in place for 2.5 months on average).

Results: Subjectively, all patients except one were satisfied with the result (mainly because of pain relief). Objectively, active motion was 65° flexion, 65° abduction, 50° internal rotation (mean fusion position 20° flexion, 25° abduction, and 30° internal rotation). Two groups were identified for assessment with the absolute Constant score. The score improved 16 points (24 to 40) in the group without instability (pain score improved from 3 to 13) and decreased 14 points (66 to 52) in patients with instability (attributed to lesser motion, mean motion scores decreasing from 38 to 14). Complications included one case each of radial palsy, non-union, and gravity oedema of the upper limb.

Discussion: Pain relief and stability are not the sole objectives of shoulder arthrodesis. The procedure can also provide useful improvement in function (hand mouth, hand perineum, thoracobrachial clamp. It can be useful if prosthetic arthroplasty cannot be used (infectious arthritis, advanced osteoarthritis in young subjects and failed stabilisation of multidirectional instability). It is a predictable procedure in terms of outcome. We continue to use scapulohumeral arthrodesis for rare indications.