The association of breast cancer-related lymphedema after unilateral mastectomy with shoulder girdle kinematics and upper extremity function

Baran, Eugeniusz; Yıldız, Taha İbrahim; Gürşen, Ceren; Üzelpasaci, Esra; Özgül, Serap; Düzgün, İrem; Akbayrak, Türkan

doi:10.1016/j.jbiomech.2021.110432

Cited by 10 publications

(15 citation statements)

References 45 publications

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“…Another important aspect of this study is that it can help to plan the care and needs of people with BC by increasing, to a greater degree, the joint balance of the external rotation of the shoulder compared to conventional treatments since, as observed by Roser Belmonte et al [56], the loss of strength for external rotators and range of motion of the shoulder and health-related quality of life in the physical domains and the arm persists at 5 years in the groups of patients operated on for BC. Similarly, Emine Baran et al [57] described that BCRL patients have a lower active shoulder range of motion on all measures than unaffected people without BCRL.…”

Section: Discussionmentioning

confidence: 85%

Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial

Muñoz-Alcaraz

Jiménez-Vílchez

Santamaría-Peláez

et al. 2022

JCM

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Background: Lymphedema, secondary to breast cancer (BCRL), is the abnormal accumulation of protein-rich fluid in the interstitium caused by a malfunction of the lymphatic system. It causes swelling, deficiencies in upper limb functions and structures, sensory pain and emotional alterations, which have a chronic course and affect the upper limb’s functionality. This study aims to verify the efficacy and efficiency in the upper limb´s functionality of a protocolized experimental approach based on occupational therapy, TAPA (activity-oriented proprioceptive antiedema therapy), in the rehabilitation of BCRL in stages I and II, comparing it with the conservative treatment considered as the standard, complex decongestive therapy (CDT), through a multicenter randomized clinical trial. Methods: a randomized and prospective clinical trial was conducted with experimental and control groups. Women diagnosed with BCRL belonging to institutions in Córdoba and Aragon (Spain) participated. Sociodemographic variables and those related to the functionality of the affected upper limb were evaluated before and after the intervention. Results: The results showed statistically significant differences in the analysis of covariance performed for the variable joint balance of the shoulder´s external rotation (p = 0.045) that could be attributed to the intervention performed; however, the effect size was minimal (η2 ≤ 0.080). In the rest of the variables, no significant differences were found. Conclusions: TAPA may be an alternative to the conservative treatment of women with BCRL. It was shown to be just as effective for volume reduction and activity performance as CDT but more effective in improving external rotation in shoulder joint balance.

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Section: Discussionmentioning

confidence: 85%

Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial

Muñoz-Alcaraz

Jiménez-Vílchez

Santamaría-Peláez

et al. 2022

JCM

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“…Indeed, similar observations were made by other authors, who reported about an association between quickDASH score and lymphedema severity. 30 This is most likely not only related to limb volume but also to skin and tissue fibrosis that limit range of motion and upper extremity strength.…”

Section: Discussionmentioning

confidence: 99%

PROMs after Lymphatic Reconstructive Surgery: Is There a Correlation between Volume Reduction and Quality of Life?

Grünherz

Barbon

Gousopoulos

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Patients with upper limb lymphedema and lower limb lymphedema experience a wide range of physical and psychological symptoms that affect quality of life. The benefits of lymphatic reconstructive surgery for patients with lymphedema are undisputed. However, recording volume reduction alone may be insufficient with regard to postoperative outcome because measurements are often inadequate, depend on many factors, and do not reflect improvement in quality of life. Methods: We conducted a prospective single center study patients receiving lymphatic reconstructive surgery. Patients received volume measurements preoperatively and at standardized postoperative intervals. To evaluate patient-reported outcomes, patients completed the following questionnaires: LYMPH-Q Upper Extremity Module, quickDASH, SF 36, Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema, and Lower Extremity Functional Scale at the aforementioned intervals. Results: We included 55 patients with upper limb lymphedema (24%) and lower limb lymphedema (73%) of lymphedema grades I-III. Patients received lymphovenous anastomosis only (23%), free vascularized lymph node transfer (35%) or a combination of both (42%). Analysis of patient-reported outcome measurements revealed improvements with respect to a broad range of complaints, particularly physical function, symptoms, and psychological well-being. There was no correlation between the extent of volume reduction and improvement in quality of life (Pearson correlation coefficient below ±0.7; P > 0.05). Conclusions: Based on a broad range of outcome measurements, we observed an improved quality of life in almost all patients, even in those without measurable volume loss of the extremity operated on, which emphasizes the need for a standardized use of patient-reported outcome measures to evaluate the benefits of lymphatic reconstructive surgery.

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“…Other structural factors (i.e., chest tightness and lymphedema; Baran et al, 2021; Haddad et al, 2013; Lee et al, 2019; Levy et al, 2012), psychological factors (i.e., pain catastrophizing, negative affect; Akbas et al, 2021; Boquiren et al, 2016), and functional factors (i.e., the presence of subacromial pain; Galiano‐Castillo et al, 2011; Lang et al, 2019, 2022; Lang, Kim, et al, 2020; Lang, Milosavljevic, et al, 2020; Prieto‐Gómez et al, 2020; Rasmussen et al, 2021; Shamley et al, 2009) are currently only cross‐sectionally related to motor behavioral outcomes, without further assessment of moderating mechanisms explaining their relationship. Since only prospective research can clarify the role of these factors on the development of altered motor behavior, there is a clear gap in current knowledge around their effective contribution to upper limb motor behavior.…”

Section: Discussion Including Future Researchmentioning

confidence: 99%

“…In cross‐sectional research in BCS between 6 months and 5 years after surgery, less ROM in shoulder flexion, shoulder abduction, shoulder external rotation and elbow extension is observed in BCS with lymphedema as compared to BCS without lymphedema (Haddad et al, 2013). Furthermore, a decreased shoulder abduction ROM, decreased scapulothoracic upward rotation and scapulothoracic increased anterior tilt is observed in BCS with severe lymphedema in comparison to BCS without lymphedema in the long‐term following surgery (Baran et al, 2021).…”

Section: Factors Associated With Upper Limb Movement Behaviormentioning

confidence: 99%

Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review

Baets

Vets

Emmerzaal

et al. 2022

The Anatomical Record

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Breast cancer is the most commonly diagnosed cancer among women and many women suffer from persistent physical and psychological complaints following their cancer treatment. Altered motor behavior at the shoulder region and upper limb, that is, alterations in movement patterns, spatiotemporal movement characteristics and muscle activation patterns, is a common physical consequence of breast cancer treatment, that can have a clear impact on daily life functioning and quality of life. Furthermore, altered upper limb motor behavior is suggested to relate to upper limb pain, which is very commonly reported in breast cancer survivors (BCS). This review, prepared according to the SANRA guidelines, looks into the current understanding of alterations in motor behavior at shoulder and upper limb in BCS, by discussing the factors related to this altered behavior. In this, we specifically focus on the relation between motor behavior and pain. Results of our search show that cancer treatment modality is predictive for shoulder range of motion. Furthermore, single prospective studies show depressive symptoms, living alone, being non‐white and low physical activity levels as predicting factors for reduced shoulder range of motion. Pain as factor related to altered motor behavior is only assessed in cross‐sectional research, limiting its interpretation in context of being cause or consequence of motor behavioral adaptations, and on the underlying mechanism explaining their relation. It is concluded that studies which explain the mechanisms how and in which subgroup of BCS motor behavioral alterations are associated with pain at the upper limb, are necessary in future.

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The association of breast cancer-related lymphedema after unilateral mastectomy with shoulder girdle kinematics and upper extremity function

Cited by 10 publications

References 45 publications

Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial

Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial

PROMs after Lymphatic Reconstructive Surgery: Is There a Correlation between Volume Reduction and Quality of Life?

Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review

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