Avaliação da postura e dos movimentos articulares dos membros superiores de pacientes pós-mastectomia e linfadenectomia

Abstract

Objective:To evaluate alterations in posture and range of motion of the upper limbs in women after mastectomy and lymphadenectomy, submitted to radiotherapy as adjuvant treatment.Methods:Two groups were evaluated: 16 post-mastectomy women with lymphedema of the upper limb and 14 post-mastectomy women without lymphedema. Patients were submitted to analysis made by software, one for posture and the other to measure ranges of movement of the shoulder, elbow, and wrists. The results obtained were compared between the right and left sides, and operated and non-operated sides, and then were submitted to statistical tests.Results:Both groups presented with anteriorization of the trunk. The women with lymphedema had head rotation to the right, protrusion of the left shoulder, and trunk inclination angle smaller on the operated side, besides bilateral elevation of the scapula when compared to the group with no lymphedema. Changes in range of motion were also smaller on the operated side in terms of flexion, abduction, and external rotation of the shoulder for all women, and for those with lymphedema, elbow extension and wrist flexion had a smaller range of motion.Conclusion:Women submitted to mastectomy presented with asymmetries and modifications in posture, and lymphedema seemed to worsen this condition. Additionally, they had deficits in range of motion in the shoulders on the operated side. Women with lymphedema also showed deficits in the elbows and wrist.

Postura corporal: Uma revisão sistemática sobre métodos de avaliação

“…The evaluation was conducted through observation, using as a benchmark the posturography test in which the individual is wearing swimsuits and barefoot. (34) j) Clinical Posturogram was used in 1 study: Haddad et al (36) . Posture assessment was performed with the capture of six images with the individual in orthostatic position (ventral and back sides, left and right profile) and anterior trunk flexion (anterior and lateral views).…”

“…For range of motion assessments were checked: surface projection of the center of the glenohumeral joint laterally; greater and lesser tubercle of the humerus; center of the olecranon; styloid process of the ulna; acromion; surface projection of the center of the elbow joint; center between radius and ulna distally). (36) Considering the analysis methods used, it can be seen that there was no uniformity in the choice of the method for the evaluation of body position. However, it was found that most of the reviewed studies used PAS (5,11,13,15,18,19,23,25,26,(29)(30)(31)33,35,37) .…”

“…In relation to studies that perform a qualitative description, most made the description of postural changes found, others showed the frequency of postural changes (6,9,10,12,17,27) , other studies used the frequency of changes and the descriptive analysis (21,36) , others just used the descriptive analysis of changes (13,22,24,30,34) , only two studies used the classification in regular, moderate and severe (16,28) . It was observed interested studies to assess the posture of children (10,12,16,26,28) , of teens (9,12,(15)(16)(17)25) , of adults (5,7,8,11,13,14,(18)(19)(20)(21)(22)(23)(30)(31)(32)(33)(34)36,37) and elderly (6,24,27,…”

Cuidado nutricional no linfedema pós-mastectomia

“…Radioterapia, quimioterapia, hormonioterapia, bem como a mastectomia -ressecção do tumor, que pode ser do tipo conservadora ou radical, essa última quando associada à linfonodectomia axilar -, são os tratamentos indicados para o câncer de mama, obtendo-se bons resultados na sobrevida e qualidade de vida dessa população. 1,3 Contudo, quando há retirada dos linfonodos axilares, junto com o tratamento de radioterapia pós-operatória, aumenta-se o risco de desenvolver o linfedema de braço, que é uma complicação comum e que interfere diretamente no cotidiano e na qualidade de vida desses indivíduos 3 . O linfedema de braço é definido como acúmulo de líquido, altamente proteico e de origem linfática, nos espaços intersticiais, determinado por deficiência na absorção ou condução da linfa.…”

“…Ele prejudica seriamente as atividades sociais e pode gerar depressão e ansiedade, não permitindo que se esqueça do sofrimento causado pela doença e seu tratamento 6 . O linfedema, portanto, pode ser considerado como doença crônica e apresenta como principais complicações: edema, fibrose pós-radioterapia, mobilidade restrita e dor 3 . Além disso, a presença da proteína no espaço intersticial pode aumentar o risco de infecção, tumores, ferimentos e diminuir a capacidade de regeneração tecidual 4,7 .…”