Surgical Options

Surgical management of malignant tumors of the shoulder girdle involves one of two routes:

Forequarter Amputation

Amputation is the alternative of last resort in modern management of shoulder sarcomas. It a causes significant loss of function not only in the affected shoulder, but also in the healthy part of the upper extremity, the elbow, wrist, and hand. They must also learn to live with the poor cosmetic results of such operations.

Limb-sparing Resection

With the advent of improved neoadjuvant chemotherapy, contemporary orthopaedic oncologists are increasingly able to safely remove these tumors while sparing the healthy limb. A variety of these often cosmetically and functionally more appealing surgical options exist today. They are classified according to the amount of bone and soft tissue resected.

Musculoskeletal Tumor Society (MSTS) Classification26

Note: A designates intact abductors, B designates resected abductors. The classic Tikhoff-Linberg procedure is the MSTS Classification S123B. 

Malawer Classifications1

Malawer Classification Type IV is the classic Tikhoff-Linberg procedure. In addition to the bony resection, it includes an extra-articular resection of the glenohumeral joint as well as any involved musculature arising from or inserting onto the scapula or proximal humerus.

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