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Bones of the Upper Limb: Humerus01:19

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The upper limb consists of the arm, forearm, wrist, and hand bones. The humerus is the single bone of the upper arm region. Proximally, it has a large, spherical, smooth head that articulates with the glenoid cavity of the scapula to form the glenohumeral or shoulder joint. The margin of the head is the anatomical neck, a residual epiphyseal plate. Laterally it extends to form bony projections called the greater tubercle and the lesser tubercle. Next to the tubercles is the surgical neck, a...
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Related Experiment Video

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Reverse Total Shoulder Arthroplasty
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Reverse geometry shoulder replacement for proximal humeral metastases.

R A Kapur1, P A McCann, P P Sarangi

  • 1Leeds Teaching Hospitals NHS Trust, UK.

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Summary

Reverse shoulder arthroplasty effectively manages proximal humerus bone metastases in rotator cuff deficient patients. This surgical approach offers pain relief and restores upper limb function without complications.

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Area of Science:

  • Orthopaedic Surgery
  • Oncology
  • Musculoskeletal Oncology

Background:

  • Skeletal metastases, particularly in the proximal humerus, cause significant pain and disability in cancer patients.
  • Management of these metastases presents challenges for orthopaedic surgeons, impacting patient morbidity.
  • Proximal humeral metastases can lead to severe pain and loss of function, diminishing quality of life.

Purpose of the Study:

  • To evaluate the efficacy of reverse geometry proximal shoulder replacement in managing proximal humeral metastatic disease.
  • To assess the potential for pain relief and restoration of functional range of movement in rotator cuff deficient patients.
  • To present a novel surgical strategy for a challenging orthopaedic oncology problem.

Main Methods:

  • Retrospective case report of three patients with proximal humeral metastases and rotator cuff disease.
  • Surgical intervention involved reverse geometry proximal shoulder replacement.
  • Outcomes assessed included pain levels, functional range of movement, and surgical complications.

Main Results:

  • All three patients experienced significant postoperative symptomatic relief.
  • Upper limb function was preserved following the surgical intervention.
  • No surgical complications were reported in any of the cases.

Conclusions:

  • Reverse geometry proximal shoulder replacement is a valuable and effective option for managing proximal humeral metastatic disease.
  • This approach is particularly beneficial in patients with concomitant rotator cuff deficiency.
  • The strategy provides a pain-free, functional range of movement, improving patient outcomes.