DISTAL UPPER EXTREMITY FUNCTION FOLLOWING PROXIMAL HUMERAL RESECTION AND RECONSTRUCTION FOR TUMORS - CONTRALATERAL COMPARISON

Background: Most functional analyses after limb salvage operations abo ut the shoulder have focused on proximal function with the assumption that distal function is largely unaffected. This analysis examines dis tal function objectively. Methods: Objective laboratory data regarding distal upper extremity strength after reconstructive procedures for t umors near the shoulder joint was collected over a 16-year period. Thi rty-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 wit h 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 ext ension, followed by elbow flexion, forearm supination, and forearm pro nation. Grip strength consistently showed the least amount of strength reduction compared with the uninvolved side, even within resection an d 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 ''n ormal'' function in the distal upper extremity after limb salvage proc edures, complete normality is not maintained. However, the degree of m aintenance of distal function appears to be high, especially for grip strength and forearm pronation strength, and patient satisfaction is a cceptable.