Impact of carpal tunnel syndrome surgery on women with breast cancer-related lymphedema

Abstract

Carpal tunnel syndrome may occur in women with ipsilateral lymphedema after breast cancer treatment. Surgery on the lymphedematous arm is classically feared. Thirty-two consecutive women (mean age at cancer treatment 49 years, interquartile range (Q1;Q3) 43;56) with upper limb lymphedema after breast cancer treatment, followed in a single lymphology unit, and symptomatic carpal tunnel syndrome (electromyographically confirmed) requiring surgery were included. Lymphedema volume was calculated using the truncated cone formula, recorded before and after carpal tunnel syndrome surgery, and at each follow-up visit. Median time to lymphedema onset after cancer treatment was 19 (interquartile range (Q1;Q3) 5;73) months. Median lymphedema volume was 497 (Q1;Q3 355;793) mL before (median 4 months) and 582 (Q1;Q3 388;930) mL after carpal tunnel syndrome surgery (median 5 months) (P = 0.004). At the last follow-up post-carpal tunnel syndrome surgery (median 33 months), lymphedema volume was 447 (Q1;Q3 260;733) mL (non-significant, compared to pre-surgery volume). Regular lymphedema treatment included elastic sleeve (n = 31), low-stretch bandage (n = 20), and/or manual lymph drainage (n = 20), with no change before and after carpal tunnel syndrome surgery. All carpal tunnel syndrome clinical manifestations disappeared after surgery and none of the patients experienced local complications. Carpal tunnel syndrome may be treated surgically in women with ipsilateral upper limb lymphedema after breast cancer treatment. Although lymphedema volume increased transiently, it remained stable over long-term follow-up, with no local complications.

Medical Procedures Safety for Breast Cancer Survivors Considering Lymphedema: A Systematic Review

“…One prospective study reported that arthroplasty worsened BCRL [8]. CTR was exclusively studied in 4 articles and none have reported any long-term changes in limb volume [14,25,26,29].…”

Carpal tunnel syndrome

“…Sekundarni SKT dijelimo na one koji su uzrokovani reduciranim volumenom KT-a (traume karpalnih kostiju, dislokacije ili subluksacije, prijelomi radiusa, osteosinteza radiusa, osteoartritis (OA) i reumatoidni artritis (RA), infekciozni artritis, rizartroza, akromegalia) ili abnormalnostima sadržaja KT-a (upalni tenosinovitis, upalni reumatizam, dijabetes, metabolički sindrom, dislipidemija, hipertenzija, trudnoća, kronične bubrežne bolesti, vaskularni poremećaji, poremećaji koagulacije) [14][15][16][17][18] . Granulomatozne upale (tuberkuloza ili lepra) mogu dovesti do SKT-a zbog kompresije NM-a granulomom 19 . Bland 7 u svom radu povezuje prekomjernu tjelesnu težinu i dob pacijenata te pokazuje da pretilost i dob znatno utječu na pojavu SKT-a.…”

“…nakon mastektomije, nakon uboda insekta ili nakon kardiokirurških zahvata) može izazvati SKT. Tumori koji uzrokuju SKT mogu biti u KT-u ili u njegovoj okolini, najčešće se nalaze lipomi, sinovijalne ciste, sinovijalni sarkomi ili neuralni tumori (švanom, neurofibrom ili lipofibrom) [19][20][21] . Prevalencija SKT-a dokazano je povećana kod osoba koje rade učestale pokrete sa šakama, posebno kod zanimanja kod kojih se šake zadržavaju u neprimjerenom položaju (fleksija ručnog zgloba) duže vremena.…”

Surgical Treatment of Carpal Tunnel Syndrome and Lymphedema in Advanced-Stage Upper Extremity Lymphedema

“…Gunnoo et al [5] demonstrated a signi cant increase in 5-month postoperative lymphedema volume compared to the preoperative volume in patients with lymphedema and CTS. Recent advances in supermicrosurgery have evolved to treat lymphedema surgically.…”