Glenohumeral (Shoulder) Fusion

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Glenohumeral Fusion to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The goal of a shoulder fusion is to create a solid bony bridge between the humerus (ball) and the glenoid (socket). This is a relatively rare procedure but when done, it usually is for deltoid (axillary nerve) paralysis. A thorough workup must be done to ensure the paralysis is truly present and will not recover on its own. A fusion is also a powerful "salvage" procedure for other complex and uncommon cases, often involving failed shoulder replacements.

When a deltoid muscle is paralyzed, the shoulder cannot function. Patients are unable to lift their arms and profound disability results. Fortunately, many of the muscles around the scapula (shoulderblade) still work and can provide good control of the arm, so long as the shoulder joint isn’t floppy. By fusing the joint, a rigid connection between the scapula and humerus is formed and a patient is able to achieve far more mobility and function through the use of their scapulothoracic articulation (the movement of their scapula on their ribs) and their elbow.

This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:

The Trial: Percutaneous Glenohumeral Pinning

Before committing to the permanent shoulder fusion, Dr. Wall offers a unique Trial Pinning Procedure. This allows you to "test drive" the experience of living with a fused shoulder before the final surgery. While not strictly necessary, it does allow patients to appreciate what life will be like after this irreversible fusion procedure.

  • The Procedure: In the operating room, temporary surgical pins are placed percutaneously through the joint, locking the shoulder into the exact position of the planned fusion.

  • The Experience: Patients then return home for 1–2 days with the pins in place. This allows them to perform daily tasks and experience how your shoulder blade and elbow will work together with a fused shoulder joint. Most patients find that their shoulder finally "works" again because the paralyzed, floppy shoulder joint is held steady. However, there is a trade off for the improved functional motion as some motion (reaching the abdomen) is always lost with shoulder fusions.

  • Safety First: During this 48-hour trial, patients must be extremely careful to avoid falls or sudden impacts so that the pins do not break.

  • The Decision: After a few days, patients must return to the clinic to have the pins removed. If the trial successfully restored function and relieved pain, then patients can move forward with the permanent fusion with more confidence in the outcome.

The Permanent Procedure

  • The Approach: Performed through an incision over the top and side of the shoulder to access the joint and the acromion.

  • Joint Preparation: Dr. Wall meticulously removes any remaining cartilage and tissue from the humeral head, the glenoid, and the underside of the acromion to expose enough bone underneath necessary for a successful fusion.

  • Anatomic Positioning: The arm is placed in a precise functional position—slightly forward, rotated inward, and abducted—ensuring you can still reach your face, and ideally top of your head.

  • Rigid Fixation: A heavy-duty, contoured metal plate and multiple long screws are used to compress the humerus against the scapula, holding the bones still until they fuse into a single unit over the following months.

Post-Op Protocol

  • Immobilization (Phase 1: 0–8 weeks): A specialized shoulder immobilizer or a strictly maintained sling is required at all times, including during sleep. No shoulder motion of any kind is permitted. Elbow, wrist, and hand motion are encouraged several times a day.

  • Start Formal PT: Professional physical therapy typically begins at post-operative Week 8, following X-ray confirmation of early bone healing.

  • Phase 2 (8–16 weeks): The brace is discontinued. Therapy focuses on scapulothoracic motion—teaching the muscles around the shoulder blade to take over the movement of the arm and a CT scan is obtained at 12 weeks to confirm a successful fusion.

  • Phase 3 (16-24 weeks): Progressive strengthening of the trapezius, serratus anterior, and rhomboids begins to maximize the strength and control of the scapula for lifting and reaching.

  • Phase 4 (24+ weeks): Return to full activity as tolerated

When to Seek Care

You should schedule a consultation if:

  • You have a history of multiple failed shoulder surgeries or chronic infections preventing a successful replacement.

  • You have a "flail" shoulder with no active control due to extensive nerve or muscle damage.

  • You have been told you have axillary nerve or deltoid paralysis.