title: Longitudinal change of treatment-related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: a prospective cohort study.
abstract: OBJECTIVE
  To investigate the prevalence of upper limb dysfunction (ULD) and subtypes after breast cancer surgery and to identify factors associated with late ULD.
  
  
  METHODS
  Among 191 enrolled patients, 191 were evaluated at 3 months, 187 at 6 months, and 183 at 12 months after surgery. Pain, shoulder range of motion, muscle strength, and arm circumference were assessed. Based on symptoms and physical examinations, the types of ULD common after breast cancer treatment were diagnosed and categorized.
  
  
  RESULTS
  The prevalence of ULD after surgery were 24.6%, 20.9%, and 26.8% at 3, 6, and 12 months, respectively. The most common types of ULD were pectoralis tightness at 3 and 6 months and lymphedema at 12 months. Patients with pectoralis tightness or lymphedema at 3 or 6 months showed a higher prevalence of rotator cuff disease at 12 months compared with those without early pectoralis tightness or lymphedema.
  
  
  CONCLUSIONS
  The major post-operative ULD were pectoralis tightness at 3 and 6 months and lymphedema at 12 months. Late ULD such as rotator cuff disease were associated with pectoral tightness or lymphedema at earlier stages. Diagnosis and treatment of ULD should take place as soon as possible after surgery.
authors.affiliation: Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 463-707, Republic of Korea.
authors.forename: Eun Joo
authors.initials: EJ
authors.lastname: Yang
authors.forename: Won-Beom
authors.initials: WB
authors.lastname: Park
authors.forename: Kwan Sik
authors.initials: KS
authors.lastname: Seo
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Kim
authors.forename: Chan-Yeong
authors.initials: CY
authors.lastname: Heo
authors.forename: Jae-Young
authors.initials: JY
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008209:Lymphedema / Q000453:epidemiology; D008408:Mastectomy / Q000009:adverse effects*; D015412:Mastectomy, Segmental / Q000009:adverse effects; D008875:Middle Aged; D053580:Muscle Strength; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D016059:Range of Motion, Articular; D021701:Sentinel Lymph Node Biopsy; D034941:Upper Extremity / Q000503:physiopathology*