Reconstruction of the Shoulder and Humerus in Metastatic Bone Disease

Metastatic disease involving the skeleton most often affects the spine, pelvis, and proximal long bones of the extremities. In the upper extremity, the proximal humerus is frequently affected. Although many of the principles of managing metastatic bone disease are similar, regardless of the metastatic site, the upper extremity has some unique anatomic and functional traits that warrant consideration when making management decisions. The main anatomic differences from the lower extremity pertain to the smaller bone size, rotator cuff function, and proximity to major neurologic structures, and the important functional differences that relate to activities of daily living have a greater dependence on the upper, rather than lower, extremity; greater range of motion of the shoulder; side dominance; limited weight-bearing function; and marked propensity of the elbow to develop stiffness. Clinicians should consider aspects of the shoulder and humerus as they relate to the overall management of metastatic bone disease, either monostotic or polyostotic, when evaluating and managing metastatic lesions at this site.