SCAPULOTHORACIC FUSION

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Scapulothoracic Fusion to restore shoulder function for patients with severe, irreversible scapular destabilization in Richmond, VA, and the surrounding Central Virginia communities. This procedure is often considered a "salvage operation." It is the final pathway for patients who have failed previous reconstructive attempts or who have conditions where no other muscle transfer will work. The goal is to permanently fuse the shoulder blade to the rib cage. While this eliminates scapular motion (shrugging), it provides the rigid, stable platform necessary for the deltoid muscle to lift the arm again, often restoring the ability to perform activities of daily living like eating and grooming.

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:

Indications: When is Fusion Necessary?

Fusion is reserved for specific "end-stage" or challenging conditions:

1. Facioscapulohumeral Dystrophy (FSHD)

  • The Problem: In FSHD, the periscapular muscles (trapezius, rhomboids, serratus) progressively turn to fat and scar tissue.

  • Why Fusion: Some tendon transfers are contraindicated because the donor muscles may also degrade over time. The disease can also be severe and so fusion is often the only durable solution to stabilize the "floating scapula".

2. Failed Serratus Anterior Paralysis Treatment

  • Primary Treatment: Typically treated with a Split Pectoralis Major Transfer.

  • Salvage: If the tendon transfer fails, stretches out, or pulls loose, ST Fusion is the salvage option to restore stability.

3. Failed Trapezius Paralysis Treatment

  • Primary Treatment: Typically treated with a Triple Tendon Transfer (Eden-Lange).

  • Salvage: For patients with failed transfers or severe, rigid deformities, ST Fusion serves as the final salvage reconstruction.

4. Severe Bony Deficiency

  • The Problem: Rare cases of severe chest wall deformity, multiple rib fractures (flail chest) that healed poorly, or post-traumatic scapular bone loss.

  • Why Fusion: When the bony track is too incongruent for the scapula to slide, fusion eliminates the painful grinding.

The Procedure

  • Fixation: Dr. Wall uses heavy-duty plates and suture to physically secure the medial border of the scapula to the underlying ribs.

  • Bone Grafting: To ensure the bones fuse (grow together) into a single solid block, Dr. Wall utilizes bone graft material packed between the scapula and the chest wall.

  • Positioning: The scapula is fused in a precise position. This optimization ideally allows the patient to bring their hand to their mouth and reach the top of their head once healed.

Post-Op Protocol

Fusion takes time. The recovery is lengthy and requires strict compliance to prevent the hardware from breaking before the bone heals.

  • Immobilization (Phase 1: 0–8 weeks):

    • Strict Protection: You will be placed in a specialized brace. Absolutely no shoulder motion is allowed. Careful sponge bathing only; the arm cannot be lifted for washing. Elbow, wrist and hand motion are OK.

  • Imaging Check: A CT scan is typically obtained at Month 2 to confirm that the bone has successfully fused.

  • Mobilization (Phase 2: 2-4 months):

    • Once fusion is confirmed, you will begin physical therapy, starting with gentle progressive range of motion.

    • The Trade-off: It is important to understand that you will lose scapular motion (shrugging) permanently. However, you will gain glenohumeral (shoulder) motion (lifting the arm), ideally achieving 90–100 degrees of elevation—enough to comb your hair, eat, and function independently.

  • Strengthening (Phases 3: 4+ months) Progressive strengthening once motion is optimized, gradual return to activities.

When to Seek Care

You should schedule a consultation if:

  • You have a diagnosis of FSHD and are losing the ability to lift your arm to feed yourself.

  • You have had a previous scapular surgery (like a tendon transfer) that has failed to relieve your winging.

  • You are willing to accept the loss of shoulder blade motion in exchange for a stable, painless arm for daily tasks.