A Short-Term Longitudinal Study on Arm/Shoulder Functions Following Breast Cancer Surgery and Its Implications on Shoulder Physiotherapy
摘要
Enhanced survival following breast cancer diagnosis has brought into focus various long term sequelae of treatment, one of the most common of which are arm/shoulder problems (ASPs).
ObjectivesTo study arm and shoulder functions in the post operative period and early follow up to elucidate the role of surgery in the etiopathogenesis of ASPs and to develop a pragmatic plan for shoulder physiotherapy.
MethodsThis prospective longitudinal study was conducted on (n = 53) patients, who underwent surgery for operable breast cancer. Evaluation of shoulder function was done at 2, 4, and 12 weeks after surgery. Main outcome measures were: (1) Restriction in range of shoulder movement (ROM) assessed using Goniometer; (2) Arm strength measurement using Hand grip dynamometer; (3) Arm/shoulder function assessment using Kwan’s Arm Problem scale (KAPS).
ResultsAt 2 weeks, 66% patients showed a significant restriction in flexion and 53% in abduction of shoulder, which had reduced to 7.5% and 9.4% respectively by 12 weeks. Arm strength was significantly reduced at all the three assessments. At 2 weeks, 72% patients had significant arm/shoulder dysfunction (KAPS score > 21.5), while none at 12 weeks. Arm and shoulder pain and use of arm were the items with highest mean scores.
ConclusionEarly initiation of structured physiotherapy and an emphasis on both mobility and strength restoration can achieve near complete functional recovery within three months.