Tumours of the upper limb

Tumours are unusual around the elbow but the proximal humerus is a relatively common site. It is the third most common site for both osteosarcomas and fibrosarcomas, after the distal femur and proximal tibia. Treatment is on conventional lines. The shoulder is the second most common peripheral site after the proximal femur for chondrosarcomas, and the scapula body is also a common site. The principal method of treatment for chondrosarcomas is surgical excision and this may be technically difficult around the shoulder. Subtotal excision of the scapula can be carried out with good preservation of function if the glenoid can be left. The humerus is also a relatively common site for lymphomas and Ewing’s tumour. Treatment is, again, along conventional lines.

Benign and intermediate tumours such as osteochondromas, giant cell tumours and aneurysmal bone cysts are also relatively common. The proximal humerus is the most common site for unicameral bone cysts, which are thought to represent an abnormality of cells of the growth plate. They commonly present as pathological fractures in children around the age of 10 and affect boys more commonly than girls. The lesion may resolve after fracturing but local medical treatment is often required (Fig. 22.20).

The humeral shaft is a common site for secondary deposits and intramedullary nailing may be required for pathological fracture or impending fracture. The majority of primary tumours is found in the breast or prostate, but secondary spread from the thyroid, lung, kidney and bowel can also occur.