Arthrodesis of the shoulder following brachial plexus injury

A series of 13 arthrodeses of the shoulder in adults with brachial plexus injuries have been reviewed. Using internal fixation and external splintage we aimed at a final position of 30 degrees abduction, 30 degrees flexion and 20 degrees of internal rotation. Patients were followed up for between 24 and 60 months. In only one was bony union not achieved, although the resulting fibrous union was asymptomatic. All patients had additional procedures including plexus exploration in six, Steindler procedure in two, triceps to biceps transfer in two, latissimus dorsi transfer in two, and above-elbow amputation in three. All patients stated that shoulder fusion had improved the function of their limb. Minimum range of movement was 50 degrees abduction and 40 degrees flexion. Two patients continued to complain of pain despite solid fusions. Compression arthrodesis of the shoulder is an effective method of achieving fusion and reliably improves the function in adults with brachial plexus injury.