Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer

Abstract

Purpose-To determine the extent and time course of upper limb impairment and dysfunction in women being treated for breast cancer, and followed prospectively, using a novel physical therapy surveillance model post-treatment.Patients and Methods-Subjects included adult women with newly diagnosed, untreated, unilateral, Stage I to III BC and normal physiological and biomechanical shoulder function. Subjects were excluded if they had a previous history of BC, or prior injury or surgery of the affected upper limb. Measurements included body weight, shoulder ranges of motion (ROM), manual muscle tests, pain levels, upper limb volume, and an upper limb disability questionnaire (ULDQ). Measurements were taken at baseline (pre surgery), and one, three-six, and 12 months post surgery. All subjects received pre-operative education and exercise instruction and specific physical therapy (PT) protocol after surgery including ROM and strengthening exercises.Results-All measures of function were significantly reduced one month post surgery, but most recovered to baseline levels by one year post surgery. Some subjects developed signs of lymphedema 3-12 months post surgery, but this did not compromise function. Shoulder abduction, flexion, and external rotation, but not internal rotation ROM, were associated with the ULDQ.Conclusion-Most women in this cohort undergoing surgery for BC who receive PT intervention may expect a return to baseline ROM and strength by three months. Those who do not reach baseline, often continue to improve and reach their pre-operative levels by one year post surgery. Lymphedema develops independently of shoulder function three to 12 months post surgery, necessitating continued monitoring. A prospective physical therapy model of surveillance allows for detection of early and later onset of impairment following surgery for BC in this specific cohort of patients.

Fisioterapia Na Flexibilidade Do Ombro Pós Cirurgia De Câncer De Mama: Revisão Sistemática

“…(9) A hipomobilidade do membro, provocada pela imobilização prolongada, por medo de sentir dor ou ocorrer deiscência da cirurgia, assim como o tipo de cirurgia, o tamanho da incisão, realização de linfonodectomia axilar e traumatismos no nervo torácico longo, levam a esta limitação. (8,10) A redução da ADM provoca impacto negativo na funcionalidade dos indivíduos acometidos. (11,12) A reabilitação de pacientes mastectomizadas se dá por uma assistência multiprofissional.…”

Application of a domicile-based exercise program for shoulder rehabilitation after breast cancer surgery

“…The shoulder is subject to the rapid installation of stiffness and muscle atrophy after breast cancer surgery, with the flexion and abduction movements the most affected (7)(8) . The prolonged immobilization caused by fear and/or pain, as well as the type of surgery, the incision size, the performance of axillary lymphadenectomy, long thoracic nerve trauma or muscle spasm throughout the cervical region, arising from the muscular defense reaction, are factors that cause women to have a tendency toward little movement of the upper limb (9)(10) . To decrease the 37 www.eerp.usp.br/rlae Petito EL, Nazário ACP, Martinelli SE, Facina G, Gutiérrez MGR.…”

“…To decrease the 37 www.eerp.usp.br/rlae Petito EL, Nazário ACP, Martinelli SE, Facina G, Gutiérrez MGR. incidence of these complications, studies highlight that the performance of exercises immediately after surgery gives positive results, both in the physical and the psychological areas, since it provides conditions for the woman to return to their activities of daily living (ADLs) within a shorter period of time (4,9,11) .…”

“…Few studies, however, report on exercise performed exclusively in the domicile (2)(3)13) . In common, all the programs present a preoperative evaluation and a gradual progression in the exercises, starting early, from the 1 st postoperative day (PO) (2)(3)6,9,12,(14)(15) . Only one study recommends the initiation of the exercise program after removal of the drain (13) , and another later, after the 6 th or 26 th postoperative week (5) .…”

Clinician's Commentary on Singh et al.

“…1 These preliminary findings are supported in previous research by Springer and colleagues that found significant improvements in shoulder function; 3 however, while this study was prospective in design, it had no control group. 3 Beurskens and colleagues 4 have also reported beneficial effects of physiotherapy with postoperative intervention, but no preoperative intervention was included in their study.…”