Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a chief complaint of progressive, dull, aching pain in the proximal humerus, exacerbated by activity and nocturnal rest. No history of acute trauma. Symptoms include localized swelling, decreased shoulder range of motion, and occasional mechanical symptoms. No constitutional symptoms such as fever or weight loss.
Clinical Examination Findings
Inspection reveals localized fullness over the proximal humerus. Palpation demonstrates tenderness at the humeral head/metaphysis with no palpable mass or warmth. Shoulder range of motion is restricted in abduction and external rotation secondary to pain. Neurovascular exam of the upper extremity is intact (distal pulses 2+, capillary refill <2s, sensation intact in axillary, radial, ulnar, and median nerve distributions).
Treatment Protocol
Plan includes surgical management via intralesional curettage with high-speed burring and adjuvant therapy (e.g., phenol, cryotherapy, or bone cement/PMMA) to minimize recurrence risk. Consideration for internal fixation if structural integrity is compromised. Referral to orthopedic oncology for multidisciplinary management and serial radiographic surveillance (MRI/CT) to monitor for local recurrence.