Upper Limb Function After Breast Cancer Surgery: the Role of Post-operative Physical Therapy Intervention

Surgical treatments can cause late effects influencing activity of daily living, physical activity, and overall health. Late effects include persistent pain reported by 30 - 50% of women that underwent breast operations, restrictions of arm and shoulder movement were reported in 35% of patients, lymphedema in 15 - 25% of women who undergo axillary lymph node dissection and in about 6% of women who undergo sentinel lymph node biopsy. Lymphedema results in physical impairments including compromised function, diminished strength, fatigue, and pain in the affected arm . The axillary web syndrome is a self-limiting and frequently overlooked cause of significant morbidity in the early postoperative period after breast cancer, which is characterized by axillary pain that runs down the medial arm, limited shoulder range of motion (ROM) . Physiotherapy and exercise in the postoperative period can result in a significant improvement in shoulder ROM in women treated for breast cancer, Additionally, exercises are an effective intervention to improve quality of life, cardiorespiratory fitness, physical functioning and fatigue in breast cancer patients. However, in the postoperative period consideration should be given to the early implementation of exercises because of the potential for seroma and increases in wound drainage volume and duration. There is limited evidence on the influence of postoperative physiotherapy intervention, and instruction program on upper limb range of motion and return to physical activity divided by the type of surgery and regarding complications.

Sex

Female

Minimum age

18 Years

Maximum age

65 Years

Inclusion Criteria:

* Women
* Age 18-65.
* Diagnosed with breast cancer, undergoing breast surgery,
* Functional independence prior to the operation.
* Ability to communicate in Hebrew.

Exclusion Criteria:

* Cognitive disorders, patients unable to sign the consent form.
* Back and spinal morbidity.
* Fibromyalgia or chronic pain disorders.
* Neurological disorders.
* Renal failure with the need for dialysis.
* Lymphedema prior to surgery.
* History of breast surgery.
* Shoulder surgery or shoulder injuries with limited ROM.
* Ischemic heart disease, heart failure and radical heart insufficiency.
* Radical mastectomy, LD and DEIP reconstruction, exchange breast prosthesis.

• DERIVEDKlein I, Kalichman L, Chen N, Susmallian S. A comprehensive approach to risk factors for upper arm morbidities following breast cancer treatment: a prospective study. BMC Cancer. 2021 Nov 20;21(1):1251. doi: 10.1186/s12885-021-08891-5. PMID 34800988