It's cool when Mel Gibson does it in the Lethal Weapon movies – dislocates his shoulder whenever he wants. But for Gord Jensen, his shoulder would pop out of its socket without any effort, even when he lay in bed. In 1989, Jensen, a cook from Windsor, Ontario, Canada, was in a head-on car crash. The steering wheel caught his left shoulder directly in the socket. The impact blew out his shoulder, pushing the shoulder three inches below the shoulder capsule and dislocating the ball from the socket.
For the next eleven years, Jensen would have nearly every possible surgery to try and repair the damage: shoulder stabilization, laser shrinkage (to shrink the shoulder capsule), shift capsular procedure (cutting the tendons to try and tightened up the shoulder), and rotator cuff repair. Every time the outcome was the same: his shoulder would still constantly dislocate.
"I couldn't take it anymore," says the 35-year-old. "When I'd walk and move my arms, I could actually feel the whole arm drop and hear a knocking noise … Even opening up the fridge door, it would buckle out."
In the fall of 2000, the doctor told him he had one last option for his now-useless shoulder: a little-performed operation known as shoulder fusion surgery, or arthrodesis .
"My surgeon told me it would never get better and eventually get worse." Jensen also ran the risk of getting arthritis and eventually losing the use of his left arm.
Shoulder fusion can stabilize the joint, but it severely restricts movement of the shoulder joint even in younger patients. Many people who choose to have shoulder fusion already very limited use of their shoulder because of their original injury or condition. For Jensen, the surgery was his only chance to regain somewhat of a normal life.
Dr. David Bailie of The Orthopedic Clinic Association in Scottsdale, AZ, gives his patients an idea of what their limitations will be before fusion surgery. He uses a "pre-op brace in various positions to make sure the patient understands where the hand and arm will be and if they can tolerate a fusion."
In shoulder fusion, the surgery can be done with a general anesthesia or a regional block to freeze the affected shoulder and adjacent side of the face. The remaining cartilage in the shoulder joint is removed, and the bone is prepared so there is a good bleeding surface for healing. The humerus (upper arm bone) and the glenoid (shoulder socket) are prepared by grinding off all of the cartilage that is left and shaping the ends of the bones to fit together, using power tools not unlike those found in your garage. This ensures that there is good contact. A bone graft is taken, usually from the hip, and the bone chips are used with screws, wires and/or plates to secure the bones together until they fuse. The fused shoulder is then placed in a brace to hold it in the correct position for three-to-six months until solid fusion takes place.
After the five-hour procedure, Jensen was in a cast for ten weeks and has a scar that runs from his spine to four inches above his elbow. Three months after the cast came off, he started rehabilitation – lifting light weights and applying ice packs.
"I gained (the) range of motion that my doctor wanted. (My) doctor was ecstatic that everything worked out perfect."
According to Dr. Bailie, patient satisfaction with shoulder fusion is between 80 and 85 percent. Some people do have scapular pain in the back around the shoulder blade and that can be problematic. Complications are reported in about 15% of shoulder fusions and usually consist of failed fusion (non-union) requiring more bone grafting, scapular pain and infection. Nerve injury is possible, but the muscles that would become paralyzed – deltoid, supraspinatus & infraspinatus (rotator cuff) – are not needed after the fusion.
At times, Jensen still has some problems – mostly the limitations on his activities. He can only lift about ten pounds with his left arm and cannot reach over his head, but he has no regrets.
"I've never felt this great before my accident … It doesn't hurt me at all. It looks like I still have the hanger in my shirt."
