title: Winged scapula incidence and upper limb morbidity after surgery for breast cancer with axillary dissection.
abstract: The aim of this study was to determine the incidence of winged scapula after breast cancer surgery, its impact on shoulder morbidity and difference in incidence according to surgery type.
  
  
  
  Patients with breast cancer and surgical indication for axillary dissection were included. A total of 112 patients were surveyed with one physical evaluation before the surgery and others 15, 30, 90, and 180 days after. Winged scapula was assessed with test proposed by Hoppenfeld. Shoulder range of motion (ROM) was assessed with goniometer for flexion, extension, adduction, abduction, internal rotation, and external rotation. A verbal scale from 0 to 10 was used to assess pain.
  
  
  
  Winged scapula incidence was 8.0 % 15 days after surgery. Two patients recovered from winged scapula 90 days after surgery and four more 180 days after surgery, while three patients still had winged scapula at this time. The incidence after 15 days from surgery was 20.9 and 22.6 % among patients submitted to sentinel node biopsy or axillary lymphadenectomy (AL), respectively (p < 0.01). There was no statistical difference of incidence according to breast surgery type. Operated side shoulder flexion, adduction, and abduction ROM changes were statistically different in patients with or without winged scapula. The mean reduction was higher in patients with winged scapula. Both groups showed the same pattern over time in pain.
  
  
  
  Winged scapula incidence was 8.0 % and was higher in AL, and prevalence decreased during 6 months after surgery. Patients who developed winged scapula had more shoulder flexion, adduction, and abduction limitation.
authors.affiliation: Department of Gynecology, Federal University of São Paulo, Rua Marselhesa, 249. Vila Mariana, Sao Paulo, SP, 04020-060, Brazil. samyfisio@gmail.com.
authors.forename: Samantha Karlla Lopes de Almeida
authors.initials: SK
authors.lastname: Rizzi
authors.affiliation: Department of Gynecology, Federal University of São Paulo, Rua Marselhesa, 249. Vila Mariana, Sao Paulo, SP, 04020-060, Brazil.
authors.forename: Cinira Assad Simão
authors.initials: CA
authors.lastname: Haddad
authors.affiliation: Department of Gynecology, Federal University of São Paulo, Rua Marselhesa, 249. Vila Mariana, Sao Paulo, SP, 04020-060, Brazil.
authors.forename: Patricia Santolia
authors.initials: PS
authors.lastname: Giron
authors.affiliation: Department of Gynecology, Federal University of São Paulo, Rua Marselhesa, 249. Vila Mariana, Sao Paulo, SP, 04020-060, Brazil.
authors.forename: Thaís Lúcia
authors.initials: TL
authors.lastname: Pinheiro
authors.affiliation: Department of Gynecology, Federal University of São Paulo, Rua Marselhesa, 249. Vila Mariana, Sao Paulo, SP, 04020-060, Brazil.
authors.forename: Afonso Celso Pinto
authors.initials: AC
authors.lastname: Nazário
authors.affiliation: Department of Gynecology, Federal University of São Paulo, Rua Marselhesa, 249. Vila Mariana, Sao Paulo, SP, 04020-060, Brazil.
authors.forename: Gil
authors.initials: G
authors.lastname: Facina
mesh_terms: D001365:Axilla / Q000601:surgery; D001943:Breast Neoplasms / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects*; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012540:Scapula / Q000294:innervation / Q000503:physiopathology*; D012782:Shoulder / Q000294:innervation / Q000503:physiopathology*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
keywords: Breast neoplasms; Morbidity; Peripheral nerve injuries; Scapula; Shoulder