Clinical Orthopaedics and Related Research®

, Volume 467, Issue 8, pp 2090–2097 | Cite as

Scapulothoracic Arthrodesis in Facioscapulohumeral Dystrophy with Multifilament Cable

  • Mehmet Demirhan
  • Ozgur Uysal
  • Ata Can Atalar
  • Onder Kilicoglu
  • Piraye Serdaroglu
Original Article


Patients with facioscapulohumeral dystrophy (FSHD) are affected mostly by impaired shoulder function. Scapulothoracic arthrodesis was introduced to improve shoulder function. We evaluated the outcomes of scapulothoracic arthrodesis using multifilament cables, performed on 13 patients with FSHD (18 shoulders). There were eight males and five females (mean age, 29 years; range, 20–50 years). Outcome criteria were active shoulder forward flexion and abduction, the Disabilities of the Arm, Shoulder, and Hand (DASH) score, respiratory function tests, and a new shoulder function score. Patients were followed for a minimum of 24 months (average, 35.5 months; range, 24–87 months). Solid fusion was obtained in all shoulders (two after revision); active abduction range increased from 47.2° ± 11.6° to 102.2° ± 10.0° (mean ± standard deviation) and anterior flexion range from 55.6° ± 16.1° to 126.1° ± 20.9°. The DASH score decreased from 33.6 ± 8.9 points preoperatively to 11.6 ± 8.0 points postoperatively. Shoulder function score increased from 15.9 ± 2.4 points to 22.2 ± 1.3 points. Scapulothoracic arthrodesis provides satisfactory function in patients with FSHD. Our data suggest use of multifilament cables for fixation is a reasonable option with an acceptable complication rate.

Level of Evidence: Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.


  1. 1.
    Berne D, Laude F, Laporte C, Fardeau M, Saillant G. Scapulothoracic arthrodesis in facioscapulohumeral muscular dystrophy. Clin Orthop Relat Res. 2003;409:106–113.PubMedCrossRefGoogle Scholar
  2. 2.
    Bunch WH, Siegel IM. Scapulothoracic arthrodesis in facioscapulohumeral muscular dystrophy: review of seventeen procedures with three to twenty-one-year follow-up. J Bone Joint Surg Am. 1993;75:372–376.PubMedGoogle Scholar
  3. 3.
    Copeland SA, Levy O, Warner GC, Dodenhoff RM. The shoulder in patients with muscular dystrophy. Clin Orthop Relat Res. 1999;368:80–91.PubMedCrossRefGoogle Scholar
  4. 4.
    Cumming WJK. Facioscapulohumeral syndrome. In: Lane RJM, ed. Handbook of Muscle Disease. London, UK: Informa Healthcare; 1996:275–286.Google Scholar
  5. 5.
    Diab M, Darras BT, Shapiro F. Scapulothoracic fusion for facioscapulohumeral muscular dystrophy. J Bone Joint Surg Am. 2005;87:2267–2275.PubMedCrossRefGoogle Scholar
  6. 6.
    Felice KJ, North WA, Moore SA, Mathews KD. FSH dystrophy 4q35 deletion in patients presenting with facial-sparing scapular myopathy. Neurology. 2000;54:1927–1931.PubMedGoogle Scholar
  7. 7.
    Giannini S, Ceccarelli F, Faldini C, Pagkrati S, Merlini L. Scapulopexy of winged scapula secondary to facioscapulohumeral muscular dystrophy. Clin Orthop Relat Res. 2006;449:288–294.PubMedGoogle Scholar
  8. 8.
    Gilbert JR, Stajich JM, Speer MC, Vance JM, Stewart CS, Yamaoka LH, Samson F, Fardeau M, Potter TG, Roses AD, et al. Linkage studies in facioscapulohumeral muscular dystrophy (FSHD). Am J Hum Genet. 1992;51:424–427.PubMedGoogle Scholar
  9. 9.
    Horwitz MT, Tocantis LM. Isolated paralysis of the serratus anterior muscle. J Bone Joint Surg Am. 1938;20:720–725.Google Scholar
  10. 10.
    Howard RC. Thoraco-scapular arthrodesis. J Bone Joint Surg Br. 1961;43:175.Google Scholar
  11. 11.
    Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder, and Hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29:602–608.PubMedCrossRefGoogle Scholar
  12. 12.
    Jakab E, Gledhill RB. Simplified technique for scapulocostal fusion in facioscapulohumeral dystrophy. J Pediatr Orthop. 1993;13:749–751.PubMedGoogle Scholar
  13. 13.
    Jeon IH, Neumann L, Wallace WA. Scapulothoracic fusion for painful winging of the scapula in nondystrophic patients. J Shoulder Elbow Surg. 2005;14:400–406.PubMedCrossRefGoogle Scholar
  14. 14.
    Ketenjian AY. Scapulocostal stabilization for scapular winging in facioscapulohumeral muscular dystrophy. J Bone Joint Surg Am. 1978;60:476–480.PubMedGoogle Scholar
  15. 15.
    Letournel E, Fardeau M, Lytle JO, Serrault M, Gosselin RA. Scapulothoracic arthrodesis for patients who have facioscapulohumeral muscular dystrophy. J Bone Joint Surg Am. 1990;72:78–84.PubMedGoogle Scholar
  16. 16.
    Personius KE, Pandya S, King WM, Tawil R, McDermott M. Facioscapulohumeral dystrophy natural history study, standardization of testing procedures and reliability of measurements. Phys Ther. 1994;74:253–263.PubMedGoogle Scholar
  17. 17.
    Putti V. L’osteodesi interscapolare in un caso di miopatia atrofica progressiva. Arch Orthop. 1906;23:319–331.Google Scholar
  18. 18.
    Rhee YG, Ha JH. Long-term results of scapulothoracic arthrodesis of facioscapulohumeral muscular dystrophy. J Shoulder Elbow Surg. 2006;15:445–450.PubMedCrossRefGoogle Scholar
  19. 19.
    Tawil R, McDermott MP, Mendell JR. Facioscapulohumeral muscular dystrophy: design of natural history study and results of baseline testing. Neurology. 1994;44:442–446.PubMedGoogle Scholar
  20. 20.
    Twyman RS, Harper GD, Edgar MA. Thoracoscapular fusion in facioscapulohumeral dystrophy: clinical review of a new surgical method. J Shoulder Elbow Surg. 1996;5:201–205.PubMedCrossRefGoogle Scholar
  21. 21.
    Whitman A. Congenital elevation of scapula and paralysis of serratus magnus muscle. JAMA. 1932;99:1332–1334.Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2009

Authors and Affiliations

  • Mehmet Demirhan
    • 1
  • Ozgur Uysal
    • 1
  • Ata Can Atalar
    • 1
  • Onder Kilicoglu
    • 1
  • Piraye Serdaroglu
    • 2
  1. 1.Department of Orthopaedics and Traumatology, Istanbul Medical FacultyIstanbul UniversityIstanbulTurkey
  2. 2.Department of Neurology, Neuromuscular Unit, Istanbul Medical FacultyIstanbul UniversityIstanbulTurkey

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