title: Shoulder Strength Changes One Year After Axillary Lymph Node Dissection or Sentinel Lymph Node Biopsy in Patients With Breast Cancer.
abstract: To assess the changes in shoulder strength of patients with breast cancer during the first year after surgery; and to compare the effect of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) on shoulder strength.
  
  
  
  Prospective longitudinal observational study from presurgery to 1 year after.
  
  
  
  Tertiary hospital.
  
  
  
  Of 129 consecutive patients examined for eligibility, a sample of women (N=112) with breast cancer were included (44 underwent ALND, and 68 underwent SLNB).
  
  
  
  Not applicable.
  
  
  
  Difference between the affected and unaffected arm in strength of shoulder external rotators, internal rotators, abductors, and serratus anterior, measured by dynamometry. Evaluations were performed prior to surgery and at 1, 6, and 12 months after surgery.
  
  
  
  After breast cancer ALND surgery, strength decreased significantly at the first month for internal rotators, without having recovered presurgery values after 1 year of follow-up, with a mean difference of 2.26kg (P=.011). There was no significant loss of strength for patients treated with SLNB. The loss of shoulder range of motion was only significant the first month for the ALND group. The factors identified as associated with strength loss in the general estimating equation models were the ALND surgery and having received physical/occupational therapy during follow-up.
  
  
  
  One year after breast cancer surgery, patients treated with ALND had not recovered their previous shoulder internal rotators strength, whereas those who underwent SLNB presented no significant loss of strength. This provides important information for designing rehabilitation programs targeted specifically at the affected muscle group after nodal surgical approach.
authors.affiliation: Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Monleon
authors.affiliation: Departament de Ginecologia y Obstetricia, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Health Services Research Unit, Hospital del Mar Medical Research Institute, Barcelona, Spain; Centro de Investigación Biomédica En Red, Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Montse
authors.initials: M
authors.lastname: Ferrer
authors.affiliation: Medicina Física i Rehabilitació, Hospital del Mar, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Tejero
authors.affiliation: Health Services Research Unit, Hospital del Mar Medical Research Institute, Barcelona, Spain; Centro de Investigación Biomédica En Red, Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Angels
authors.initials: A
authors.lastname: Pont
authors.affiliation: Medicina Física i Rehabilitació, Hospital del Mar, Barcelona, Spain.
authors.forename: Merce
authors.initials: M
authors.lastname: Piqueras
authors.affiliation: Departament de Medicina, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Medicina Física i Rehabilitació, Hospital del Mar, Barcelona, Spain; Hospital del Mar Research Institute, Barcelona, Spain. Electronic address: rbelmonte@parcdesalutmar.cat.
authors.forename: Roser
authors.initials: R
authors.lastname: Belmonte
mesh_terms: D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000601:surgery*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008197:Lymph Node Excision / Q000009:adverse effects*; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology*; D053581:Muscle Strength Dynamometer; D018482:Muscle, Skeletal / Q000503:physiopathology; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*; D012782:Shoulder / Q000503:physiopathology*; D062606:Tertiary Care Centers; D013997:Time Factors
keywords: Breast neoplasms; Lymph node excision; Muscle strength; Rehabilitation; Shoulder