Total scapulectomy and constrained reverse total shoulder reconstruction for a Ewing's Sarcoma

Abstract

The goal of shoulder reconstructions is to provide a stable and painless joint that allows positioning of the arm and hand in space. Compared to those patients left without a scapula reconstruction, prosthetic replacement of the scapula and shoulder partially restores abduction and external rotation and improves cosmesis.

Primary malignant tumours of the scapula—a review of 29 cases

“…Apart from a few small series and limited case reports international literature on scapula tumours is exiguous and in this context knowledge about the surgical and oncological outcome is limited. Unfortunately, these tumours often grow quite large before being diagnosed and during disease progression the extension of the tumour to surrounding structures may occur [5][6][7][8]. Therefore, physicians must be sensitized to recognize these lesions, though these symptoms are rather unspecific.…”

“…Most common tumours involving the scapula are chondrosarcoma in adolescents and Ewing's sarcoma in children [3]. Tumours affecting the scapula often grow quite large before being diagnosed, and during disease progression the extension of the tumour to the chest wall, the proximal humerus, the rotator cuff or the neurovascular bundle may occur [5][6][7][8]. Considering these as potential risk factors for local recurrence, limb sparing resections for malignant tumours of the scapula were long considered high-risk procedures.…”

“…The first total scapulectomy was performed and described by Syme in 1856 [9,10]. Since then several modifications and different indications have been published in small series and case reports [1,[3][4][5][6][7][11][12][13][14][15][16]. Later, in 1928, Linberg described the interscapulothoracic resection (Tikhoff-Linberg).…”

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

“…The indications for RTSA have expanded over the last few years and include CTA [15,18,26,50,57,61], inflammatory arthropathy with massive rotator cuff tear [26,45], proximal humeral nonunion or malunion [6,34,57], acute fractures [34,57,58], fixed glenohumeral dislocation [57], posttraumatic arthritis [26,57], tumor [4,13,35,57], revision arthroplasty [6,27,33,57], and chronic pseudoparalysis without arthritis [41,57,60,61]. We will limit our discussion to problems dealing with the rotator cuff.…”

“…The RTSA was originally designed to treat a massive irreparable rotator cuff with superior migration of the humeral head combined with glenohumeral arthritis (cuff tear arthropathy [CTA]) [5,15,18,21,40]. The indications have expanded however, and currently it is being used for multiple diagnoses including fracture sequelae [6,31,32,34,58], revision arthroplasty [6,27,33,57], instability [57], and tumors [4,13,35,57]. As a result of its success with these problems, its indications are gradually increasing, and many are unsure about its role in the treatment of rotator cuff disease.…”