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Case Report

Rehabilitation and functional result after total scapulectomy without protetization

Ana Margarida Ribeiro, Filipe Rodrigues, Raquel Lage Araújo, Diogo Moniz Costa, Alexandre Lopes, Pedro Cardoso, Maria João Miranda.

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Although chondrosarcomas are common malignant bone tumors, the incidence of scapular
chondrosarcoma is relatively rare. Surgical resection is the fundamental treatment as this type of tumor has limited response to radio and chemotherapy. Limb sparing solutions with or without scapular protetization are nowadays preferred. Rehabilitation of this sort of procedure is challenging and program design depends greatly on the level of bone and soft tissue preservation. Final functional result correlates with glenoid and rotator cuff function preservation. The authors present a case of a 41 year-old male with scapular chondrosarcoma grade I who underwent
Malawer III surgical treatment. Surgical team decided for a limb sparing procedure without scapular protetization. Reconstruction procedure included humeral head fixation to the distal end of clavicle and to a Trevira® mesh. The patient underwent a 12-week individualized rehabilitation program. Follow-up with clinical examination and functional scale assessment (Quick Disabilities of the Arm, Shoulder and Hand and Musculoskeletal Tumor Society Score for Upper Extremity) was performed at first
evaluation (M0), one month (M1) three months (M2) and two-year time (M3). At the end of the 12 weeks rehabilitation program, patient had limited active shoulder range of motion and strength. Mobility and motor strength on distal segments (elbow and hand) were preserved but overall strength and functionality of left upper extremity were compromised. To our knowledge, there are few reports of the functional results on patients with total scapulectomy and detailing the rehabilitation program.
We believe rehabilitation approach to these patients should be tailored to surgical approach and follow-up must include standardized functional and clinical evaluation.

Key words: bone neoplasms, soft tissue neoplasms, scapular chondrosarcoma, scapulectomy, rehabilitation

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