Forty-one arthrodeses of the shoulder in thirty-nine patients suffering from rheumatoid arthritis (thirty women, nine men) have been reviewed. Using internal fixation and external splints the position of the shoulder was maintained in 55 degrees of abduction, 25 degrees of horizontal flexion and enough internal rotation to allow the patient to reach the mouth. The mean period of immobilisation in a thoracobrachial splint was nine weeks, and 90 per cent of the shoulders had solid bony fusion at review. After arthrodesis the total range of scapulothoracic movement improved by about 60 per cent, giving results rated as excellent in fifteen cases (36 per cent), as good in thirteen (32 per cent) and as fair in thirteen (32 per cent). Arthrodesis can be recommended as an easy, cheap and reliable method of treating a shoulder which has been severely destroyed by rheumatoid arthritis.

1. One hundred and twenty-three patients with rheumatoid arthritis who had synovectomy and excision of the head of the radius performed on 154 elbows have been reviewed one to six years after operation.

2. The severity of the disease process at the time of operation was graded radiologically and an attempt made to relate this to the results.

3. Overall, the clinical results were most satisfactory; more than 70 per cent of the patients were pleased with the outcome. When radiographic deterioration of the joint was taken into account, however, only 54 per cent achieved a "satisfactory" result.

4. Clearance of the synovium through combined medial and lateral incisions gave better results than a lateral approach alone.

5. When the disease was far advanced by the time of operation any good results were likely to be short-lived.

6. The indications for synovectomy of the rheumatoid elbow are discussed in the light of these findings.