Summary:The use of metal implants for the surgical management of problems about the shoulder has become a common and effective part of our treatment armamentarium. The anatomy of the shoulder, however, makes it less tolerant of rigid metallic implants. Therefore, extreme care should be exercised in their use. This should include adequate exposure or arthroscopic visualization during insertion, intraoperative radiographs to document accurate placement, and follow-up radiographs to identify potential problems related to migration, loosening or breakage. Finally, to avoid some of the complications associated with the use of metallic implants, nonmetallic alternatives should be utilized for the treatment of many of the common clinical problems encountered. Procedure selection should depend primarily on the risk/benefit ratio, not the ease with which the procedure can be performed.