FUNCTIONAL LABORATORY ASSESSMENT AFTER ONCOLOGIC SHOULDER JOINT RESECTIONS

A laboratory evaluation was undertaken to assess the shoulder range of motion and distal strength after oncologic resection and reconstructi on involving the shoulder joint and to compare these functional parame ters based on potentially important variables, Inclusion in the study was limited to 32 patients with bone tumors of the proximal humerus or scapula treated surgically by resection of the shoulder joint includi ng the proximal humerus from 1976 through 1992, Active shoulder range of motion and isometric elbow extension and forearm supination strengt h are significantly less after surgery in patients with greater amount s of bony resection and with resection of the deltoid. Patients who ha d a modified Tikhoff-Linberg resection mere able to achieve 10 degrees to 15 degrees greater shoulder motion in each direction than were pat ients who had the classic procedure including complete scapulectomy. H owever, elbow flexion and extension strength and forearm pronation str ength were greater for the patients with the classic resection. Osteoa rticular allografts as a reconstructive alternative provide as a group the best shoulder motion and overall distal upper extremity strength, but these reconstructions were performed only when the rotator cuff m uscles and deltoid were able to be reconstructed, Diminishing elbow st rength was seen with longer follow up in the patients with osteoarticu lar reconstructions, corresponding temporally to subchondral collapse observed on radiographs. Range of shoulder motion except rotation mas just as good for allograft vascularized fibular arthrodeses as for the osteoarticular allografts, but strength was significantly less with t he arthrodeses.