title: The efficacy of physiotherapy upon shoulder function following axillary dissection in breast cancer, a randomized controlled study.
abstract: BACKGROUND
  Many patients suffer from severe shoulder complaints after breast cancer surgery and axillary lymph node dissection. Physiotherapy has been clinically observed to improve treatment of these patients. However, it is not a standard treatment regime. The purpose of this study is to investigate the efficacy of physiotherapy treatment of shoulder function, pain and quality of life in patients who have undergone breast cancer surgery and axillary lymph node dissection.
  
  
  METHODS
  Thirty patients following breast cancer surgery and axillary lymph node dissection were included in a randomised controlled study. Assessments were made at baseline and after three and six months. The treatment group received standardised physiotherapy treatment of advice and exercises for the arm and shoulder for three months; the control group received a leaflet containing advice and exercises. If necessary soft tissue massage to the surgical scar was applied. Primary outcome variables were amount of pain in the shoulder/arm recorded on the Visual Analogue Scale, and shoulder mobility (flexion, abduction) measured using a digital inclinometer under standardized conditions. Secondary outcome measures were shoulder disabilities during daily activities, edema, grip strength of both hands and quality of life. The researcher was blinded to treatment allocation.
  
  
  RESULTS
  All thirty patients completed the trial. After three and six months the treatment group showed a significant improvement in shoulder mobility and had significantly less pain than the control group. Quality of life improved significantly, however, handgrip strength and arm volume did not alter significantly.
  
  
  CONCLUSIONS
  Physiotherapy reduces pain and improves shoulder function and quality of life following axillary dissection after breast cancer.
authors.affiliation: Centre for Allied Health Research, Department of Physiotherapy, Radboud University Nijmegen Medical Centre, P,O, Box 9101, 6500 HB Nijmegen, The Netherlands. c.beurskens@fysiocss.umcn.nl
authors.forename: Carien H G
authors.initials: CH
authors.lastname: Beurskens
authors.forename: Caro J T
authors.initials: CJ
authors.lastname: van Uden
authors.forename: Luc J A
authors.initials: LJ
authors.lastname: Strobbe
authors.forename: Rob A B
authors.initials: RA
authors.lastname: Oostendorp
authors.forename: Theo
authors.initials: T
authors.lastname: Wobbes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000502:physiology / Q000601:surgery*; D001943:Breast Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012782:Shoulder / Q000502:physiology*; D016037:Single-Blind Method