Shoulder and Elbow Cases to Consider.

Last updated Friday, August 29, 2008

Figure 1

Shoulder arthrodesis for spondylo-epiphyseal dyspl

Clinical presentation

This is the radiograph of a 70 year old woman with spondylo-epiphyseal dysplasia who has had severe limitation of her right shoulder motion since birth. Over the last few years she has progressively experienced severe pain which prevents her from using this arm and from sleeping. She also uses a wheel chair for ambulation because of dysplastic involvement of her spine, hips and knees. Her left shoulder remains relatively unaffected.

On examination her right shoulder is relatively fixed in internal rotation. Any use or motion of the joint is painful for her and produces crepitance. Her attitude is very positive.

Our concerns include :

1. Marked disuse osteopenia.
2. The technical difficulty of a shoulder arthroplasty.
3. The potential for improved function after an arthroplasty due to the chronicity of her condition.
4. The feasibility and potential benefit of an arthrodesis.

Management

The patient clearly identified pain at rest and on use of her shoulder as her primary problem; she had thoroughly adapted to the loss of motion. Because of her serviceable left arm and her need for a strong right shoulder for transfers and wheel chair ambulation, we recommended a shoulder arthrodesis using internal fixation for immediate return to function.

At surgery the virtual absence of glenohumeral motion was verified. The shoulder was fused in the same position it had assumed for 70 years: slight flexion and abduction with 45 degrees of internal rotation. The arthrodesis was secured with a pelvic reconstruction plate. She began using her arm on the first post operative day. Three months after surgery the shoulder was essentially painless and allowed function in the necessary activities of daily living.

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