A 77-year-old woman presented with metastatic urothelial carcinoma as an elbow mass. To our knowledge, this is only the third reported case of urothelial carcinoma metastasizing to the upper extremity. The presence of metastatic disease at the time of diagnosis of urothelial carcinoma is rare, with metastases to the upper extremities even less common. This case is interesting given that the mass occurred after a direct trauma, causing a delay in diagnosis. It highlights the importance of a multidisciplinary oncology approach, and the need for more research to understand the biology of metastases. [Orthopedics. 2025;48(1):e52-e55.].