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especially in patients with poorer prognosis. Concomitant effects of radiotherapy and chemotherapy,
including increased risk for scarring, wound healing problems, and infection, should also be considered.
These factors differ from a non-oncology orthopedic patient and should be considered prior to finalizing a
surgical plan.

The glenohumeral joint significantly relies on the dynamic stabilizers and force-couplers to allow for
[6]
range of motion of the shoulder, including the rotator cuff, glenohumeral ligaments, and deltoid . These
[7]
structures comprise the functional anatomic compartment of the shoulder . During wide resection of
the proximal humerus for oncology surgery, major portions of the functional anatomic compartment are
often removed. Those portions can specifically include all or the deep portion of the deltoid, subscapularis
muscle belly, superior-posterior rotator cuff musculature, latissimus dorsi, brachialis, and portions of the
triceps. Wide resection of this functional compartment during surgery creates a complex situation during
reconstruction, especially when trying to restore both stability and function to the shoulder and proximal
[7]
humerus . When the rotator cuff is going to be compromised or resected, a reverse total shoulder
arthroplasty (RTSA) implant should be considered. Need for resection of the brachial artery and/or all of
the three major nerves affecting distal function (radial, median, and ulnar) are considered contraindications
for limb salvage surgery, but resection of the axillary nerve is not.

INDICATIONS
The proximal humerus is a common location for upper extremity tumors. Common tumors requiring
resection affecting the proximal humerus include metastatic bone disease, myeloma, primary bone
sarcomas, and locally aggressive benign tumors.

Metastatic Bone Disease/Myeloma
Metastatic bone disease and myeloma commonly affect the proximal humerus. Common primary
carcinomas that metastasize to bone include prostate, breast, kidney, thyroid, and lung. Breast and lung are
the most common in females. Prostate and lung are the most common in males. Myeloma represents the
most common primary bone cancer. In the setting of metastatic disease or myeloma involving the proximal
humerus, there are limited indications for resection. Indications in these patients include: (1) solitary or
oligometastatic renal cell carcinoma [Figures 1 and 2]; (2) extensive proximal humeral bone destruction
that makes prophylactic internal fixation unreliable or simply not feasible [Figure 3]; (3) failure of other
constructs due to tumor progression; and (4) hardware failure.

Primary Bone Tumors
The proximal humerus is a common location for primary sarcomas, including osteosarcoma, Ewing
[8]
sarcoma, and chondrosarcoma .

[8]
Osteosarcoma is the most common bone sarcoma overall and most common in pediatric patients . The
proximal humerus is the third most common location for osteosarcoma. The standard of care for treatment
of osteosarcoma includes wide surgical resection with concomitant chemotherapy [Figure 4]. The typical
metaphyseal location lends itself to intra-articular wide resection.

Ewing sarcoma is the second most common pediatric sarcoma . Although Ewing sarcoma more commonly
[8]
involves the diaphysis of long bones, it sometimes involves the metaphysis. The most common locations are
the femur and tibia, but it can occur in the humerus. Treatment with surgical resection is an alternative to
radiotherapy but favored whenever resected bone can be reconstructed, as it can in the proximal humerus.

[8]
Chondrosarcoma is the most common adult bone sarcoma . Chondrosarcoma most frequently occurs
in the pelvis, proximal femur, and proximal humerus. Treatment of grade 2 and 3 tumors is wide surgical