Recovery of upper limb function after axillary dissection.
OBJECTIVE
After surgery for breast cancer, data on the long-term impairment of upper limb activities of daily living (ADL) are scarce. The purpose of this study was to investigate the short- and long-term recovery of upper limb ADL function after surgery for breast cancer.


METHODS
Seventy-six patients, who underwent either a breast-conserving procedure with axillary dissection (BCP, n = 45) or a modified radical mastectomy (MRM, n = 31), were included. The patients were assessed on the fourth postoperative day, after 3 weeks, and after 3 months. Shoulder mobility, arm circumference, and upper limb ADL (score from 1 to 7) were evaluated.


RESULTS
In the early postoperative phase, a considerable decrease in shoulder mobility and the ability to perform upper limb ADL were observed. After 3 months, MRM patients had more limitations in shoulder mobility than BCP patients (shoulder flexion: 150 degrees vs. 126 degrees, respectively, P = 0.0001). In addition, upper limb ADL was still significantly impaired: MRM patients suffered from greater functional disabilities than BCP patients, ADL score 2.7 and 1.8, respectively (P = 0.037). Patients with axillary radiation experienced greater disability of shoulder mobility and ADL.


CONCLUSIONS
Three months after surgery for breast cancer, impaired shoulder mobility, and ADL persisted in a substantial number of patients. Type of surgery and axillary irradiation contributed significantly to upper limb recovery. This observation warrants considering continuation of physiotherapy aiming to improve restoration of upper limb function.
Gosselink
Rik
R
Department Physiotherapy, University Hospitals, Katholieke Universiteit Leuven, and Faculty of Physical Education and Physiotherapy, Katholieke Universiteit Leuven, Belgium. rik.gosselink@uz.kuleuven.ac.be
Rouffaer
Lieven
L
Vanhelden
Peter
P
Piot
Wim
W
Troosters
Thierry
T
Christiaens
Marie-Rose
MR
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D015411:Mastectomy, Modified Radical / Q000534:rehabilitation; D015412:Mastectomy, Segmental / Q000534:rehabilitation; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology; D034941:Upper Extremity / Q000503:physiopathology*