Management of upper extremity bone metastases

Metastatic bone disease represents a significant burden of disease. Metastatic disease can seed in any bone of the body, but one of the most common long bones affected is the humerus. Although painful and often disabling, metastatic bone disease of the upper extremity often can be treated more conservatively than the lower extremity because of lower weight-bearing demands. However, the surgical management of upper extremity metastatic bone disease is an evolving field, and recent clinical studies have demonstrated several key principles. Intramedullary nailing and whole bone irradiation may be an optimal combination for prophylactic fixation. The addition of polymethyl methacrylate cement adds immediate stabilization to internal fixation and decreases postoperative pain. Plate and screw fixation can be used in lesions that cannot be treated with intramedullary nailing, but caution is necessary to avoid complications related to surgical technique. Finally, periarticular and intraarticular lesions may be managed with a hemi- or total-joint prosthesis for both the shoulder and elbow to provide the maximal functional outcome. Surgical intervention together with appropriate adjunctive therapies can decrease patient-important pain and skeletal-related events while improving quality of life in patients living with metastatic bone disease of the upper extremity.