Introduction The goal of shoulder arthrodesis is to provide a stable base for the upper extremity optimizing hand and elbow function it remains an important treatment option in appropriately selected patients Indications stabilization of paralytic disorders brachial plexus palsy irreparable deltoid and rotator cuff deficiency with arthropathy salvage of a failed total shoulder arthroplasty reconstruction after tumor resection painful ankylosis after chronic infection recurrent shoulder instability which has failed previous repair attempts paralytic disorders in infancy Contraindications ipsilateral elbow arthrodesis contralateral shoulder arthrodesis lack of functional scapulothoracic motion trapezius, levator scapulae, or serratus anterior paralysis Charcot arthropathy during acute inflammatory stage (Eichenholtz 0-2) elderly patients progressive neurologic disease Anatomy Glenohumeral articulation a relatively small amount of surface area exists allowing for predictable fusion to increase the available fusion area, decortication of both the glenohumeral articular surface and the articulation between the humeral head and the undersurface of the acromion is performed only the glenoid fossa and base of the coracoid provide sufficient strength for fixation Presentation Symptoms specific to the underlying condition necessitating arthrodesis symptomatic dysfunction of the glenohumeral joint Imaging Radiographs recommended views AP, lateral, and axillary views to assess bone stock available for fusion and deformities CT better to evaluate glenoid bone loss especially in the setting of failed arthroplasty Studies EMG indicated when the neurologic condition of the scapular muscles is ill-defined Surgical Technique Approach S-shaped skin incision beginning over the scapular spine, traversing anteriorly over the acromion, and extending down the anterolateral aspect of the arm Fusion position goal is to allow patients to reach their mouths for feeding think "30°-30°-30°" 20°-30° of abduction 20°-30° of forward flexion 20°-30° of internal rotation Technique rotator cuff is resected from the proximal humerus and the biceps tendon is tenodesed glenoid and humeral head articular surfaces and the undersurface of the acromion are decorticated arm is placed into the position of fusion (30°-30°-30°) a 10-hole, 4.5 mm pelvic reconstruction plate is contoured along the spine of the scapula, over the acromion, and down the shaft of the humerus compression screws are placed through the plate across the glenohumeral articular surface into the glenoid fossa the plate is anchored to the scapular spine with a screw into the base of the coracoid Postoperative care a thermoplastic orthosis is applied the day after surgery and is maintained for 6 weeks at 6 weeks, may transition to a sling if there are no radiographic signs of loosening at 3 months, mobilization exercises and thoracoscapular strengthening are commenced if no radiographic signs of loosening are present expected recovery period is 6-12 months Complications Infection Nonunion Malposition Prominent hardware Humeral shaft fracture