A functional analysis of shoulder fusions

Seventeen shoulder fusions with relatively normal musculature were analyzed with particular interest to the ability of the fused extremity to perform activities of daily living. Joints fused for paralysis were excluded. No patient was able to work overhead or with arms abducted as required for activities such as hammering, house painting, or climbing a ladder. Many patients had difficulty functioning at head level for hygienic purposes. Many were unable to perform functions behind the back, although waist-level function approached normal. The position of rotation was the most critical factor in approaching optimum function. Fusions in positions of internal rotation reduced the ability to comb hair, wash the face, or to otherwise use the hand at head level. Fusion in a position of excessive external rotation made it impossible for the patient to reach the opposite axilla or belt buckle. There was a range of acceptability of abduction of forward flexion that did not appear to compromise the eventual functional result. The recommended position is 25 degrees to 40 degrees abduction, 20 degrees to 30 degrees flexion, and 25 degrees to 30 degrees of internal rotation. Even at the ideal position, shoulder fusion produces significant limitations in function. For patients with painful, nonfunctional shoulders who need arthrodesis, these limitations should be clearly discussed, along with the pros and cons of surgical treatment in general.