Overview of Resections around the Shoulder Girdle: Anatomy, Surgical Considerations and Classification

  • Martin Malawer
  • James Wittig


The Tikhoff-Linberg procedure and its modifications are limb-sparing surgical options for selected patients with bone and soft-tissue tumors in and around the shoulder girdle. Today, approximately 95% of patients with tumors of the shoulder girdle can be treated by a limb-sparing procedure. Forequarter amputations are rarely performed, except in cases of tumors that are infected or fungating, tumors that invade the adjacent neurovascular bundle or chest wall, and failed attempts at limb-sparing resections.Function of the forearm, wrist, and hand should be nearly normal following a limb-sparing shoulder girdle resection. A stable shoulder and elbow flexion and extension are achieved without the need for an orthosis.

This chapter describes in detail the specific tumor site and its influence on the surgical management, indications and contraindications of resection, surgical staging and classification, endoprosthetic reconstruction and design features, functional considerations, and rehabilitation. Specific techniques of resection and reconstruction of the proximal humerus and scapula are presented in Chapters 33 and 34.


Rotator Cuff Brachial Plexus Proximal Humerus Glenohumeral Joint Shoulder Girdle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Rosenberg SA, Suit FD, Baker LH. Sarcomas of soft tissue. In: Devita VT, Hellman S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology, 2nd edn. Philadelphia: JB Lippincott; 1985:1243–93.Google Scholar
  2. 2.
    Dahlin DC. Bone Tumors: General Aspects and Data on 6,221 Cases, 3rd edn. Springfield: Charles C Thomas; 1978.Google Scholar
  3. 3.
    Linberg BE. Interscapulo-thoracic resection for malignant tumors of the shoulder girdle region. J Bone Joint Surg. 1928;10:344.Google Scholar
  4. 4.
    Liston R. Ossified aneurysmal tumor of the subscapular artery. Eduil Med J. 1820;16:66–70.Google Scholar
  5. 5.
    Mussey RD. Removal by dissection of the entire shoulder blade and collar bone. Am J Med Sci. 1837;21:390–4.Google Scholar
  6. 6.
    Syme J. Excision of the Scapula. Edinburgh: Edmonston and Douglas; 1864.Google Scholar
  7. 7.
    Pack GT, Baldwin JC. The Tikhoff-Linberg resection of the shoulder girdle. Case report. Surgery. 1955;38:755–7.Google Scholar
  8. 8.
    Pack GT, Crampton RS. The Tikhoff-Linberg resection of the shoulder girdle. Clin Orthop. 1961;19:148–61.Google Scholar
  9. 9.
    Guerra A, Capanna R, Biagini R et al. Extra-articular resection of the shoulder (Tikhoff-Linberg). Ital J Orthop Traumatol. 1985;11:151–7.PubMedGoogle Scholar
  10. 10.
    Marcove RC. Neoplasms of the shoulder girdle. Orthop Clin N Am. 1975;6:541–52.Google Scholar
  11. 11.
    Marcove RC, Lewis MM, Huvos AG. En-bloc upper humeral interscapulothoracic resection. The Tikhoff-Linberg procedure. Clin Orthop. 1977;124:219–28.PubMedGoogle Scholar
  12. 12.
    Papioannou AN, Francis KC. Scapulectomy for the treatment of primary malignant tumors of the scapula. Clin Orthop. 1965;41:125.Google Scholar
  13. 13.
    Baumann PK. Resection of the upper extremity in the region of the shoulder joint. Khirurgh Arkh Velyaminova. 1914;30:145.Google Scholar
  14. 14.
    Samilson RL, Morris JM, Thompson RW. Tumors of the scapula. A review of the literature and an analysis of 31 cases. Clin Orthop. 1968;58:105–15.PubMedGoogle Scholar
  15. 15.
    Malawer MM. Tumors of the shoulder girdle: technique of resection and description of a surgical classification.Google Scholar
  16. 16.
    Malawer MM, Link M, Donaldson S. Sarcomas of bone. In: Devita VT, Hellman S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology, 3rd edn. Philadelphia: JB Lippincott; 1984:1418–68.Google Scholar
  17. 17.
    Malawer MM, Sugarbaker PH, Lambert MH et al. The Tikhoff-Linberg procedure and its modifications. In: Sugarbaker PH, editor. Atlas of Sarcoma Surgery. Philadelphia: JB Lippincott; 1984.Google Scholar
  18. 18.
    Marcove RC. Neoplasms of the shoulder girdle. Orthop Clin N Am. 1975;6:541–52.Google Scholar
  19. 19.
    Francis KC, Worcester JN. Radical resection for tumors of the shoulder with preservation of a functional extremity. J Bone Joint Surg (Am). 1962;44:1423–30.Google Scholar
  20. 20.
    Henshaw RM, Jones V, Malawer MM. Endoprosthetic replacement with the modular replacement system: survival analysis of the first 100 implants with a minimum 2-year follow-up. Presented at the Combined Meeting of the American and European Musculoskeletal Tumor Societies, 6–10 May dy1998; Washington, DC.Google Scholar

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© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Martin Malawer
  • James Wittig

There are no affiliations available

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