Upper extremity impairments in women with or without lymphedema following breast cancer treatment.
BACKGROUND
Breast-cancer-related lymphedema affects approximately 25% of breast cancer (BC) survivors and may impact use of the upper limb during activity. The purpose of this study is to compare upper extremity (UE) impairment and activity between women with and without lymphedema after BC treatment.


METHODS
144 women post BC treatment completed demographic, symptom, and Disability of Arm-Shoulder-Hand (DASH) questionnaires. Objective measures included Purdue pegboard, finger-tapper, Semmes-Weinstein monofilaments, vibration perception threshold, strength, range of motion (ROM), and volume.


RESULTS
Women with lymphedema had more lymph nodes removed (p < .001), more UE symptoms (p < .001), higher BMI (p = .041), and higher DASH scores (greater limitation) (p < .001). For all participants there was less strength (elbow flexion, wrist flexion, grip), less shoulder ROM, and decreased sensation at the medial upper arm (p < .05) in the affected UE. These differences were greater in women with lymphedema, particularly in shoulder abduction ROM (p < .05). Women with lymphedema had bilaterally less elbow flexion strength and shoulder ROM (p < .05). Past diagnosis of lymphedema, grip strength, shoulder abduction ROM, and number of comorbidities contributed to the variance in DASH scores (R (2) of 0.463, p < .001).


CONCLUSIONS
UE impairments are found in women following treatment for BC. Women with lymphedema have greater UE impairment and limitation in activities than women without. Many of these impairments are amenable to prevention measures or treatment, so early detection by health care providers is essential.
Smoot
Betty
B
Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, USA. betty.smoot@ucsf.edu
Wong
Josephine
J
Cooper
Bruce
B
Wanek
Linda
L
Topp
Kimberly
K
Byl
Nancy
N
Dodd
Marylin
M
D001943:Breast Neoplasms / Q000503:physiopathology*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000503:physiopathology*; D008875:Middle Aged; D011788:Quality of Life; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D034941:Upper Extremity / Q000503:physiopathology*