title: Periscapular amputation as treatment for brachial plexopathy secondary to recurrent breast carcinoma: a case series and review of the literature.
abstract: OBJECTIVE
  Recurrent breast carcinoma with brachial plexus involvement is often misinterpreted as a radiation- or chemotherapy-induced brachial plexopathy. We review a case series of 4 patients at our institution within a 1-year period, and describe their diagnostic workup and treatment with a palliative periscapular amputation. Our aim is to describe this entity, indications and benefits of this procedure, when required for progressive disease, with the goal of raising a collective index of suspicion to aid in earlier diagnosis.
  
  
  METHODS
  Four patients with recurrent axillary breast cancer and symptoms consistent with a brachial plexopathy were prospectively collected over a 1-year period. A Pubmed search was conducted; pertinent articles were reviewed and reported.
  
  
  RESULTS
  Patients presented with intractable pain and flaccid paralysis of the ipsilateral limb. All had been previously treated with surgical resection, axillary lymph node dissection, chemotherapy, and radiation therapy. Average time from breast surgery to presentation was 78.75 months (range 11-216 months.) Workup included MRI and biopsy to confirm recurrence. Periscapular amputation was performed for each patient, all of who experienced subjective pain relief postoperatively. Three of the 4 patients are still living; one patient died of disease.
  
  
  CONCLUSIONS
  Breast cancer survivors presenting with a brachial plexopathy should raise suspicion for recurrent disease. Close evaluation with MRI is the best first step in diagnosis. Although periscapular amputation is an aggressive surgical treatment, it is an acceptable option when disease has progressed to neurovascular involvement and a functionless limb.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, 1215 21st Ave South, Nashville, TN 37232, USA.
authors.forename: N K
authors.initials: NK
authors.lastname: Behnke
authors.forename: S N
authors.initials: SN
authors.lastname: Crosby
authors.forename: C M
authors.initials: CM
authors.lastname: Stutz
authors.forename: G E
authors.initials: GE
authors.lastname: Holt
mesh_terms: D000671:Amputation, Surgical; D001365:Axilla; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy*; D002277:Carcinoma / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010148:Intractable Pain / Q000209:etiology / Q000601:surgery; D010166:Palliative Care; D010524:Peripheral Nervous System Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D034941:Upper Extremity / Q000601:surgery
keywords: Brachial plexopathy; Breast cancer; Forequarter amputation; Periscapular amputation