Mechanosensitivity in the upper extremity following breast cancer treatment

Abstract

Study Design Descriptive, cross-sectional. Introduction Breast cancer (BC) treatments place the nervous system at risk, which may contribute to upper extremity (UE) mechanosensitivity. Purpose of the Study To evaluate elbow extension range of motion (EE-ROM) during upper limb neurodynamic testing (ULNT) post-BC treatment. Methods ULNT EE-ROM was measured for 145 women post-BC treatment. Women were sub-grouped by presence/absence of pain and lymphedema Results Mean EE-ROM during ULNT1 was −22.3° (SD: 11.9°) on the unaffected limb and −25.99° (SD 13.1°) on the affected limb. The women with pain and lymphedema had the greatest limitation in EE-ROM during ULNT1 testing, particularly of their affected limb (−33.8°, SD 12.9). Symptoms were reported more frequently in the affected chest, shoulder, arm, elbow, and hand. The intensity of symptoms was greater at the affected chest (p=0.046), shoulder (p=0.033) and arm (p=0.039). Conclusions Women with lymphedema and pain after BC treatment may present with altered neural mechanosensitivity.

An Exploratory Randomized Trial of Physical Therapy for the Treatment of Chemotherapy-Induced Peripheral Neuropathy

“…A study by Kelley and Jull 41 was one of the earliest to show sensitivity during movement in the neural tissue following breast cancer surgery, and others have replicated the results. 42 Sensitized neural tissues pre-chemotherapy may predispose the nerves to further trauma from chemotherapy and/or radiation, resulting in a double-crush syndrome or dual nerve disorder prolonging symptoms. From this, it was hypothesized that impaired thermal and vibration sense would result with the surgical side exhibiting impairments in QST.…”

Nerve Pressure Pain Hypersensitivity and Upper Limb Mechanosensitivity in Breast Cancer Survivors: A Case–Control Study

“…This process occurs as a consequence of changes in the dorsal horn interneurons involved in reflex pathways to motor neurons [45]. Recently, Smoot et al [28] studied mechanosensitivity in women after breast cancer treatment and found significant reductions in elbow extension ROM during ULNTMEDIAN in patients with pain and lymphedema, though the results were not statistically significant in patients with pain but without lymphedema. Our results partially agree with this work, as the patient group did not present lymphedema at the moment of the research but did have neck-shoulder pain.…”

“…The tests were stopped when the patient identified, at least partially, symptoms, the shoulder girdle attempted to elevate, or the examiner found muscular resistance to movement. A similar methodology has been described in studies of brachial plexus provocation tests [28,35].…”

“…In addition, Smoot et al. [28] recently assessed different groups of women with lymphedema and pain after breast cancer treatment and demonstrated an altered neural mechanosensitivity in the upper limb. However, the design of this study, using the non‐affected side as a control, did not afford knowledge of the implication of central sensitization on the mechanosensitivity process.…”

“…Brachial provocation tests have been used to clarify the mechanosensitivity of nerves in arm whiplashassociated disorder [9,25], carpal tunner syndrome [26], or lateral epicondylalgia [27]. In addition, Smoot et al [28] recently assessed different groups of women with lymphedema and pain after breast cancer treatment and demonstrated an altered neural mechanosensitivity in the upper limb. However, the design of this study, using the non-affected side as a control, did not afford knowledge of the implication of central sensitization on the mechanosensitivity process.…”