Skip to main content
SpringerLink
Log in

Distal upper extremity function following proximal humeral resection and reconstruction for tumors: Contralateral comparison

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: Most functional analyses after limb salvage operations about the shoulder have focused on proximal function with the assumption that distal function is largely unaffected. This analysis examines distal function objectively.

Methods: Objective laboratory data regarding distal upper extremity strength after reconstructive procedures for tumors near the shoulder joint was collected over a 16-year period. Thirty-two patients were able to participate fully in the data collection at an average most recent follow-up duration of >3.5 years.

Results: Statistically significant reductions on the involved side compared with the uninvolved side in grip, forearm pronation, forearm supination, elbow flexion, and elbow extension strength were documented (p<0.05). The magnitude of reduction in strength diminishes distally, with the greatest effect in this group of patients being observed in elbow extension, followed by elbow flexion, forearm supination, and forearm pronation. Grip strength consistently showed the least amount of strength reduction compared with the uninvolved side, even within resection and reconstruction groups. Subjective patient rating of dexterity was no less than 3 of 5. Ninety percent of patients rated their dexterity 4 of 5 (52%) or 5 of 5 (38%).

Conclusions: Despite the insistence of “normal” function in the distal upper extremity after limb salvage procedures, complete normality is not maintained. However, the degree of maintenance of distal function appears to be high, especially for grip strength and forearm pronation strength, and patient satisfaction is acceptable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Enneking WF, Dunham W, Gebhard MC, Malawer M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system.Clin Orthop 1993;286:241–5.

    PubMed  Google Scholar 

  2. Askew LJ, An KN, Morrey BF, Chao EYS. Isometric elbow strength in normal individuals.Clin Orthop 1987;222:261–6.

    PubMed  Google Scholar 

  3. O'Connor MI, Sim FH, Chao EYS. Limb salvage for shoulder girdle neoplasma. In:Limb salvage—current trends. Proceedings of the 7th International Symposium on Limb Salvage. Singapore, 1983:285.

  4. O'Connor MI, Sim FH, Chao EYS. Limb salvage for shoulder girdle neoplasms.J Bone Joint Surg (submitted for publication).

  5. Damron TA, Rock MG, O'Connor MI, et al. Functional laboratory assessment of reconstructive alternatives following resection of the shoulder joint for oncologic purposes: a prospective study. In: Campanacci M, Capanna R, eds.Joint Meeting of European Musculo-Skeletal Oncology Society and American Musculo-Skeletal Tumour Society. Florence, Italy 1995:23.

  6. Simon MA, Aschilman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur.J Bone Joint Surg [Am] 1968;68:1331–7.

    Google Scholar 

  7. Springfield DS, Schmidt R, Graham-Pole J, Marcus RB, Spanier SS, Enneking WF. Surgical treatment for osteosarcoma.J Bone Joint Surg [Am] 1985;67:606–11.

    Google Scholar 

  8. Otis JC, Lane JM, Kroll MA. Energy cost during gait in osteosarcoma patients after resection and knee replacement and after above-the-knee amputation.J Bone Joint Surg [Am] 1985;67:606–11.

    CAS  Google Scholar 

  9. Aboulafia AJ, Mikol EJ, Malawer MM. Custom endoprosthetic replacement of the proximal humerus following extra-articular resection for high-grade malignant bone tumors [Abstract]. Presented at the American Academy of Orthopedic Surgeons Annual Meeting, San Francisco, February 1994.

  10. Bos G, Sim F, Pritchard D, Shives T, Rock M, Askew L, Chao E. Prosthetic replacement of the proximal humerus.Clin Orthop 1987;224:178–91.

    PubMed  Google Scholar 

  11. Capanna R, Van Horn JR, Biagini R, et al. A humeral modular prostheses for bone tumor surgery: a study of 56 cases.Int Orthop 1986;10:231–8.

    CAS  PubMed  Google Scholar 

  12. Capanna R, Van Horn JR, Biagini R, Ruggieri P, Ferruzzi A, Campanacci M. The Tikhoff-Linberg procedure for bone tumors of the proximal humerus: the classical “extensive” technique versus a modified “transglenoid” resection.Arch Orthop Trauma Surg 1990;109:63–7.

    Article  CAS  PubMed  Google Scholar 

  13. Francis KC, Worcester JN. Radical resection for tumors of the shoulder with preservation of a functional extremity.J Bone Joint Surg [Am] 1962;44:1423–30.

    Google Scholar 

  14. Frassica FJ, Sim FH, Chao EYS. Primary malignant bone tumors of the shoulder girdle: surgical technique of resection and reconstruction.Am Surg 1987;53(5):264–9.

    CAS  PubMed  Google Scholar 

  15. Frassica FJ, Chao EYS, Shives TC, Sim FH. Resection of malignant bone tumors about the shoulder. A preliminary report of reconstruction with a new modular spacer.Clin Orthop 1991;267:57–65.

    PubMed  Google Scholar 

  16. Gebhardt MC, Roth YF, Mankin HJ. Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of a musculoskeletal tumor.J Bone Joint Surg [Am] 1990;72:334–45.

    CAS  PubMed  Google Scholar 

  17. Guerra A, Capanna R, Biagini R, Ruggieri P, Campanacci M. Extra-articular resection of the shoulder (Tikhoff-Linberg).Ital J Orthop Traumatol 1985;11:151–7.

    CAS  PubMed  Google Scholar 

  18. Ham SJ, Hoekstra HJ, Eisma WH, Koops HS, Oldhoff J. The Tikhoff-Lindberg procedure in the treatment of sarcomas of the shoulder girdle.J Surg Oncol 1993;53:71–7.

    CAS  PubMed  Google Scholar 

  19. Janecki C, Nelson CL. En bloc resection of the shoulder girdle; technique and indications.J Bone Joint Surg [Am] 1972;54:1754–8.

    CAS  PubMed  Google Scholar 

  20. Linberg BE. Interscapulo-thoracic resection for malignant tumors of the shoulder joint region.J Bone Joint Surg 1928;10:344–9.

    Google Scholar 

  21. Malawer MM, Sugarbaker PH, Lampert M, Baker AR, Gerber NL. The Tikhoff-Linberg procedure: report of the patients and presentation of a modified technique for tumors of the proximal humerus.Surgery 1985;975:518–28.

    Google Scholar 

  22. Malawer MM, Meller I, Dunham WK. A new surgical classification system for shoulder-girdle resections. Analysis of 38 patients.Clin Orthop 1991;267:33–44.

    PubMed  Google Scholar 

  23. Marcove RC, Lewis MN, Huvos AG. En bloc upper humeral interscapulo-thoracic resection.Clin Orthop 1977;124:219–28.

    PubMed  Google Scholar 

  24. Pack GT, Crampton RS. The Tikhoff-Linberg resection of the shoulder girdle.Clin Orthop 1962;19:148–61.

    Google Scholar 

  25. Rock MG. Intercalary allograft and custom Neer prosthesis after en bloc resection of the proximal humerus.Innovative Techniques 586–99.

  26. Rock MG, Cahalan TD, Chao EYS. Functional outcome of patients with osteoarticular allografts: reconstruction for tumors of the proximal humerus. In: Tan Ser Kiat, ed.Limb salvage: current trends. Proceedings of the 7th International Symposium. Singapore, 1993:613.

  27. Sim FH, Chao EYS, Pritchard DJ, Salzer M. Replacement of the proximal humerus with a ceramic prosthesis: a preliminary report.Clin Orthop 1980;146:161–74.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. From the Biomechanics Laboratory, Mayo Clinic, Mayo Foundation, Rochester, Minnesota

    Marjorie E. Johnson MD & Kai-Nan An MD

  2. Department of Orthopedic Surgery, Mayo Clinic, Mayo Foundation, Rochester, Minnesota

    Michael G. Rock MD, Douglas J. Pritchard MD, Franklin H. Sim MD & Thomas C. Shives MD

  3. Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida

    Mary I. O'Connor MD

  4. Department of Orthopedic Surgery, State University of New York Health Science Center, Syracuse, New York, USA

    Timothy A. Damron MD

Authors
  1. Timothy A. Damron MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael G. Rock MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mary I. O'Connor MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marjorie E. Johnson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kai-Nan An MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Douglas J. Pritchard MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Franklin H. Sim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Thomas C. Shives MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Damron, T.A., Rock, M.G., O'Connor, M.I. et al. Distal upper extremity function following proximal humeral resection and reconstruction for tumors: Contralateral comparison. Annals of Surgical Oncology 4, 237–246 (1997). https://doi.org/10.1007/BF02306616

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02306616

Key Words

Search

Navigation