Physical Therapy Intervention Following Surgical Treatment of Carpal Tunnel Syndrome in an Individual With a History of Postmastectomy Lymphedema

Abstract

Background and Purpose. This case report describes the physical therapy examination, intervention, and outcomes for a patient with lymphedema following breast cancer treatment who underwent carpal tunnel release. Case Description. The patient was a 53-year-old woman with right upper-limb lymphedema and symptoms of carpal tunnel syndrome (CTS) in her right hand who underwent a carpal tunnel release. Management of her lymphedema included the use of general anesthesia with reduced tourniquet time in conjunction with physical therapy, which included use of compression bandaging, limb positioning, and exercise. Outcomes. Following surgical release, the patient' s numbness and pain were alleviated. Right-hand grip strength increased following active exercise. Girth of the forearm decreased 1 to 1.5 cm at the 2 most distal measurement sites, and girth of the arm increased 1.5 to 2 cm 6 months after surgery. Discussion. This case supports the option of elective hand surgery for CTS in an individual with chronic lymphedema.

Hand surgery after axillary lymph node clearance for breast cancer: contra-indication to surgery?

“…Second, from a surgical perspective, it is felt that surgery could lead to development of lymphoedema (or worsen pre-existing lymphoedema) and that patients are at greater risk of complications such as postoperative infection or wound-healing problems. 1,[3][4][5][6][7] This view is reflected to some degree in the results of our own survey (Fig. 2).…”

“…The published literature on hand surgery in these particular patients is sparse with only a handful of small studies and case reports. 4,5,7,9 The reported results of hand surgery in these patients do not support the commonly perceived view that surgery carries a greater risk of devel-oping lymphoedema or postoperative infection, particularly in those patients with no pre-exiting lymphoedema. In those with pre-existing lymphoedema, there may be a risk of worsening lymphoedema when a tourniquet is used but this is possibly a temporary phenomenon.…”

“…There is evidence to suggest the risk of developing certain hand conditions such as carpal tunnel syndrome and trigger digit may actually be higher in patients after breast cancer surgery. 1,3,7 In one study of 143 breast cancer patients, 10% developed carpal tunnel syndrome post breast surgery. 3 Larson et al 8 reported that 28% of patients who had undergone breast surgery with ALNC developed carpal tunnel syndrome in their ipsi-lateral hand post surgery.…”

“…Consequently, patients are often advised to avoid interventional procedures on the ipsilateral upper extremity such as venepuncture, intravenous catheterisation and tourniquet use for blood pressure measurement. [1][2][3][4][5][6][7] However there is little in the literature to justify the view that these particular patients are at greater risk of developing such complications after hand surgery.…”

Elective Hand Surgery After Axillary Lymph Node Dissection for Cancer

“…The authors postulated that the superficial infection damaged enough of the remaining lymphatics that lymphedema ensued. 14 Donachy and Christian 15 reported a 53-year-old woman with preexisting lymphedema after ALND. After CTR with general anesthesia, reduced tourniquet time, and postoperative physical therapy, she had relief of her carpal tunnel symptoms but also a 1.5-to 2-cm increase in arm girth.…”