Randomized clinical trial on the preservation of the medial pectoral nerve following mastectomy due to breast cancer: impact on upper limb rehabilitation

Abstract

CONTEXT AND OBJECTIVE: Systematic modifications to the surgical technique of mastectomy have been proposed with the objective of minimizing injuries to the pectoral nerves and their effects. The aim of this study was to compare muscle strength and mass of the pectoralis major muscle (PMM) and abduction and flexion of the homolateral upper limb following mastectomy among women with breast cancer undergoing either preservation or sectioning of the medial pectoral nerve (MPN). DESIGN AND SETTING: Randomized, double-blind, clinical trial on 30 women with breast cancer who underwent mastectomy between July 2002 and May 2003 in Campinas, Brazil. METHODS: The women were allocated to a group, in which the MPN was preserved, or to another group in which it was sectioned. Fisher's exact and Wilcoxon tests were used to analyze the data, along with Friedman and ANOVA analysis of variance. RESULTS: In the MPN preserved group, 81% of the women did not lose any PMM strength, compared with 31% in the sectioned MPN group (confidence interval, CI = 1.21; relative risk, RR = 2.14; P < 0.03). There were no differences between the groups regarding muscle mass (CI = 0.32; RR = 0.89; P = 0.8), shoulder abduction (CI = 1.36; RR = 0.89; P = 0.28) and shoulder flexion (CI = 1.36; RR = 1.93; P = 0.8). CONCLUSIONS: Preservation of the MPN was significantly associated with maintenance of PMM strength, compared with nerve sectioning. No differences in muscle mass or in abduction and flexion of the homolateral shoulder were found between the groups.

Methodological quality of systematic reviews and clinical trials on women's health published in a Brazilian evidence-based health journal

“…The women who underwent nerve preservation had significantly higher muscle strength than those who underwent nerve sectioning. No differences in muscle mass or in abduction and flexion capacities of the homolateral shoulder were identified between the groups (16). …”

“…The CTs were on ropivacaine plus clonidine for labor analgesia (15), upper limb rehabilitation after breast cancer mastectomy with preservation of the medial pectoral nerve (16) and pelvic floor muscle training versus hypopressive exercises for pelvic organ prolapse (17). …”

“…One CT (15) did not provide information on sequence generation (selection bias), and two (16,17) did not report outcome assessors (detection bias) or blind the participants and personnel (performance bias).…”

Shoulder Mobility, Muscular Strength, and Quality of Life in Breast Cancer Survivors with and without Tai Chi Qigong Training

“…Surgical trauma together with activity avoidance may be the major causes of shoulder muscle weakness [20, 27]. It seems that TC Qigong is a suitable exercise to improve shoulder muscular strength (Table 2) and therefore QOL in CA survivors [3, 4].…”

“…The shoulder rotator muscles were assessed because they dynamically stabilize the glenohumeral joint during many functional activities, and changes in strength may result in shoulder disorders [19]. In addition, the manipulation of the pectoral muscles (major internal rotator of the shoulder) and potential injury to the pectoral nerves during mastectomy may weaken the shoulder internal rotators, which may affect the QOL of breast CA survivors [20]. …”