Indications
- Malignant tumours of the proximal humerus
- Severe trauma
- Infection or gangrene
Position
- Supine with a bolster under the scapula, or lateral
Landmarks and Incision
- Racquet incision from the coracoid along the deltopectoral groove
- Continued around the axilla to create a deltoid flap
Superficial Dissection
- Ligate the cephalic vein
- Detach pectoralis major from the humerus
- Divide coracobrachialis and short head of biceps near the coracoid
Deep Dissection
- Ligate the axillary artery and vein proximally
- Divide nerves under gentle traction for retraction away from the stump
- Release latissimus dorsi and teres major
- Divide the capsule and remaining rotator cuff to free the humeral head
Structures at Risk
- Axillary artery and vein
- Brachial plexus
Management
- Similar to a high transhumeral amputation
- Suture all proximal muscles across the glenoid to fill the cavity left by removing the humeral head
- Retaining the humeral head when tumour margins allow improves shoulder contour
- Round off the acromion for a better contour
- Deltoid flap closed over the glenoid
- Targeted muscle reinnervation can improve prosthetic control and reduce neuroma pain
Complications
- Poor shoulder contour and prosthetic fitting
- Low prosthetic use
- Neuroma and phantom limb pain
- Wound breakdown
Author Contributions
Page written by Dr James Drummond
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.