SHOULDER DYSFUNCTION AND PAIN AFTER RADICAL OR CONSERVATIVE BREAST CANCER SURGERY WITH AXILLARY APPROACH

Samantha Karlla Lopes de Almeida Rizzi, Cinira Assad Simão Haddad, Patrícia Santolia Giron, Roberta Pitta Costa Luz, Thais Lúcia Pinheiro, Patrícia Vieira Guedes Figueira, Afonso Celso Pinto Nazario, Gil Facina

 

Institution: Federal University of São Paulo

“Background: Pain and dysfunction of upper limb ipsilateral to the surgery are some of the major morbidities that may arise after surgical treatment of breast cancer. The incidence of these morbidities may be related to the type of surgery performed. The purpose of this article was to evaluate shoulder range of motion (ROM) and pain before and after breast cancer surgery, and evaluate these variables in different types of breast (conservative or radical) and axillary (sentinel lymph node biopsy or axillary lymphadenectomy) surgery. Methods: The study included 92 patients older than 18 years who underwent breast cancer surgery with axillary approach. Patients with neurological or orthopedic disorders were excluded. The patients were evaluated preoperatively and 15, 30, 90 and 180 days after surgery. A goniometer was used to assess flexion, extension, adduction, abduction, internal rotation and external rotation shoulder ROM. The Verbal Scale from 0 to 10, where 0 is “”no pain”” and 10 is “unbearable pain”” was used to investigate pain. Results: Patients submitted to radical breast cancer surgery had greater reduction from baseline of flexion, extension, adduction, abduction and external rotation shoulder ROM (p<0.05). There was a greater reduction in amplitude of flexion, extension and abduction in patients undergoing axillary lymphadenectomy (p<0,05). At the end of follow-up, patients who underwent radical surgery still had statistically greater amplitude difference of flexion, abduction and external rotation in relation to the preoperative period, when compared to those who did conservative surgery. Patients undergoing lymphadenectomy remained with greater difference form baseline of shoulder flexion and abduction 180 days after surgery (p<0,05). There was no difference between the groups in relation to the reporting postoperative pain. Conclusion: Radical breast cancer surgery and axillary lymphadenectomy led to greater shoulder motor impairment compared to breast and axillary conservative procedures, with no difference regarding pain.