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Teixeira LFN, Sandrin F, da Silva RFKC, Petrella F, Bertolaccini L, Simoncini MC, Spaggiari L. The Incidence of Winged Scapula after Thoracic Cancer Surgery: A Prospective Cohort Study. Thorac Cardiovasc Surg 2024. [PMID: 38698601 DOI: 10.1055/s-0044-1786196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related deaths, and surgery is still the first treatment of choice in early and locally advanced cases. One of the iatrogenic complications is the serratus anterior palsy, which could lead to a winged scapula (WS). Unfortunately, the incidence of this deficit in thoracic surgery is unclear. Our primary aim was to determine the incidence of WS in lung cancer patients in a single-center experience. METHODS We conducted a retrospective analysis of prospectively collected data with patients eligible for oncological thoracic surgery from March 2013 until January 2014. A physical evaluation of the WS was performed pre- and postoperatively, at the discharge and after 1 year of follow-up. RESULTS A total of 485 patients were evaluated; 135 (27.8%) showed WS. Longer operative time (p < 0.0001), type of surgery (p < 0.0001), lymphadenectomy (p < 0.0001), and neoadjuvant treatment prior surgery (p = 0.0005) were significantly related to the WS injury. Multivariable analysis showed that type of surgery was significantly associated with WS (p < 0.0001). After 1 year, 41.6% still had WS. CONCLUSION The incidence of WS was similar to the literature. As WS incidence is underdiagnosed, assessment and correct education about possible deficits or impairments should be improved. Moreover, when a minimally invasive approach is not planned, it is a good clinical practice to discuss surgical strategies with surgeons to reduce this deficit.
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Affiliation(s)
| | - Fabio Sandrin
- Department of Physiotherapy, European Institute of Oncology, Milano, Italy
| | | | - Francesco Petrella
- Thoracic Surgery Department, European Institute of Oncology, Milano, Italy
| | - Luca Bertolaccini
- Thoracic Surgery Department, European Institute of Oncology, Milano, Italy
| | | | - Lorenzo Spaggiari
- Department of Thoracic Surgery, Istituto Europeo di Oncologia, Milano, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
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Plaza Meza MP, Marín Fermín T, Maffulli N. Diagnosis and epidemiology of winged scapula in breast cancer patients: A systematic review and meta-analysis. Br Med Bull 2021; 140:23-35. [PMID: 34471931 DOI: 10.1093/bmb/ldab021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Winged scapula (WS) is a critical complication of axillary surgery in patients treated for breast cancer, and is associated with pain, impairment of the upper extremity's function and poor performance in daily activities. SOURCES OF DATA A systematic review and meta-analysis were performed following the PRISMA guidelines. Two independent reviewers searched PubMed, Embase and Virtual Health Library databases from January 1, 2000 to December 1, 2020. Clinical studies evaluating the diagnosis and epidemiology of WS among breast cancer surgery (BCS) patients were included. AREAS OF AGREEMENT The diagnosis of WS relies almost entirely on physical assessment. Studies have suggested a high variability in the report of the incidence of WS given the subjectivity of its diagnosis, and the different criteria used during clinical assessment. AREAS OF CONTROVERSY The diagnosis of WS in BCS patients remains a challenge given the lack of standardized diagnostic protocols. Physical examination cannot rely on one manoeuvre only, as it may overlook patients with subtle injuries or overweight and contributing to the underreporting of its incidence. GROWING POINTS BCS patients undergoing axillary lymph node dissection experience a significantly higher incidence of WS than those undergoing sentinel lymph node dissection. The global incidence of WS after BCS is 16.79%. Additionally, the anterior flexion test and the push-up test are the most commonly performed diagnostic manoeuvers. AREAS TIMELY FOR DEVELOPING RESEARCH Further studies should aim for objective diagnostic tests, especially when the condition is not evident.
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Affiliation(s)
- Milger P Plaza Meza
- Department of General Surgery, Hospital Universitario Periférico de Coche, Av. Intercomunal de El Valle con Calle Zea, 1090 Caracas, Venezuela.,Clínica de Prevención del Cancer, Sociedad Anticancerosa de Venezuela, Av. Norte 3, Canónigos a Esperanza, N° 43, Parroquia Altagracia, 1010 Caracas, Venezuela
| | - Theodorakys Marín Fermín
- Department of Traumatology, Hospital Universitario Periférico de Coche, Av. Intercomunal de El Valle con Calle Zea, 1090 Caracas, Venezuela
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, AOU San Giovanni di Dio e Ruggi D'Aragona, Via San Leonardo 1, 84131 Salerno, Italy.,Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, UK
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3
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Ortí-Asencio M, Salinas-Huertas S, Luzardo-González A, Terra-Falótico J, Planas-Balagué R. Scapular winging in surgical treatment of breast cancer, prospective study to optimize the follow-up protocol. Clin Transl Oncol 2021; 23:2090-2098. [PMID: 33829395 DOI: 10.1007/s12094-021-02612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION One of the most common complications of the surgical treatment of breast cancer is limited range-of-motion in the shoulder. Scapular winging is one of the most underdiagnosed shoulder mobility impairments. OBJECTIVE The main objective of this study was to determine the incidence of scapular winging in patients who underwent breast cancer surgery as the basis for expanding the protocol to patients who have had a sentinel lymph node biopsy. The secondary objective was to determine the risk factors that lead to the development of a winged scapula presented after breast cancer treatment in our sample. METHODS This was a prospective, observational, and multidisciplinary study. Between 2013 and 2018, 214 consecutive patients who had been diagnosed with breast cancer and treated for it surgically were followed by Rehabilitation Department for 3 years. The patients were evaluated in the 1st, 6th, 12th, 18th, 24th and 36th months following surgery. Scapular winging was evaluated at each visit by means of static and dynamic tests. RESULTS The cumulative incidence of scapular winging was 3.6% and seven cases of winged scapula were diagnosed. All the cases were diagnosed at the first visit, 1 month after the intervention. In the univariate analysis, the axillary lymph node dissection technique was a more significant risk factor for a winged scapula than sentinel lymph node biopsy. CONCLUSIONS The axillary lymph node dissection technique is a risk factor for developing a winged scapula. No evidence was found for any other significant risk factor.
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Affiliation(s)
- M Ortí-Asencio
- Department of Rehabilitation, Hospital Universitari Bellvitge, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - S Salinas-Huertas
- Department of Rehabilitation, Hospital Universitari Bellvitge, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - A Luzardo-González
- Department of Rehabilitation, Hospital Universitari Bellvitge, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - J Terra-Falótico
- Department of Rehabilitation, Hospital Universitari Bellvitge, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - R Planas-Balagué
- Department of Rehabilitation, Hospital Universitari Bellvitge, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
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Ormsby NM, Hawkes DH, Ng CY. Variation of surgical anatomy of the thoracic portion of the long thoracic nerve. Clin Anat 2021; 35:442-446. [PMID: 34595774 DOI: 10.1002/ca.23796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/09/2022]
Abstract
Decompression of the long thoracic nerve (LTN) is a potentially beneficial procedure for selected patients with LTN palsy. The aim of this work is to describe the surgical anatomy of the thoracic part of the LTN and highlight its variations. A retrospective review of patients undergoing exploration of the LTN was performed. Preoperatively, all patients had serratus anterior dysfunction and underwent electromyographic (EMG) assessment. All patients had an initial trial of nonoperative management. The surgical procedures were undertaken by the senior author. The anatomy of the LTN and the associated vasculature was recorded in patient records, and with digital photography. Forty-five patients underwent LTN exploration. Two patients with iatrogenic injury were excluded, leaving 43 patients for analysis. Mean age was 36 years. Sixty-seven percent of cases involved the dominant side. Trauma was the commonest cause, followed by neuralgic amyotrophy. Four patients had typical features of serratus anterior dysfunction but with normal EMG studies. Two distinct patterns of LTN anatomy were noted. In 79% of cases, a single major nerve trunk coursing along serratus anterior was observed and classified as a type I LTN. In 21% of cases, two equal major branches of the nerve were identified, which was classified as a type II LTN. Approximately one in five patients may have two major branches of the LTN. This is of clinical relevance to those who undertake any thoracic procedures, as well as those who are considering exploration of the LTN.
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Affiliation(s)
- Neal M Ormsby
- Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, WN6 9EP, UK
| | - David H Hawkes
- Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, WN6 9EP, UK
| | - Chye Yew Ng
- Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan, WN6 9EP, UK
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Luz CMD, Prim AC, Deitos J, Heck APF, Recchia TL, Mayer AF. Reliability and validity of the Upper Limb Functional Test (ULIFT) for women after breast cancer surgery. Disabil Rehabil 2021; 44:4096-4103. [PMID: 33749472 DOI: 10.1080/09638288.2021.1897885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the reliability and convergent validity of the Upper Limb Functional Test (ULIFT) in women after breast cancer surgery. MATERIALS AND METHODS A cross-sectional study with 25 women (mean age 50 ± 7.3 years) with breast cancer submitted to a surgery intervention within a minimum period of three years. Intraclass correlation coefficients (ICCs) were calculated to assess the test-retest reliability. A Bland-Altman plot examined the agreement between the times to complete two tests. Validity was established by correlating the ULIFT and DASH total score. The receiver operating characteristic (ROC) curve was used to determine the cut-off point for ULIFT in order to discriminate patients with some level of upper limb dysfunction. RESULTS The ULIFT showed high reproducibility (ICC = 0.89; p < 0.001), learning effect of 7.21%, and a moderate correlation with the DASH total score (r = 0.536; R2 = 0.28; p = 0.006). The standard error of measurement was 6.9 s and the smallest real difference was 19.1 s. The ROC curve indicated a cut-off point of 109.2 s (sensitivity = 68.7%; specificity = 77.8%; area under ROC curve = 0.77). CONCLUSIONS The ULIFT could be a valid and reliable test to assess upper limb functionality in patients submitted to breast cancer surgery.Implications for rehabilitationThe ULIFT is a reliable and valid test to assess upper limb function in women after breast cancer surgery, considering specifically the lifting and range of motion construct of unilateral upper limb function.The ULIFT could help identify those most at risk of developing upper limb dysfunction after breast cancer surgery and could benefit the follow-up of a postoperative rehabilitation program.Two ULIFTs should be performed in order to achieve patient's best performance.
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Affiliation(s)
- Clarissa Medeiros da Luz
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Amably Cristiny Prim
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Julia Deitos
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Ailime Perito Feiber Heck
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Thaís Lunardi Recchia
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
| | - Anamaria Fleig Mayer
- Department of Physiotherapy, Center of Health and Sport Sciences, Santa Catarina State University, Florianópolis, Brazil
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Tsuji K, Matsuoka YJ, Ochi E. High-intensity interval training in breast cancer survivors: a systematic review. BMC Cancer 2021; 21:184. [PMID: 33618699 PMCID: PMC7897878 DOI: 10.1186/s12885-021-07804-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/11/2021] [Indexed: 01/14/2023] Open
Abstract
Background To review the settings and outcomes of high-intensity interval training (HIIT) interventions for breast cancer survivors, and to explore the feasibility of prescribing exercise for breast cancer survivors. Methods A systematic search of electronic databases was conducted for studies published up to May 31, 2020. Eligibility criteria included randomized controlled trials of HIIT intervention in breast cancer survivors. Studies were grouped by whether the intervention was conducted during or after breast cancer treatment, and intervention methods and outcomes were reviewed within each group. Results Twenty-six studies were identified, and 13 satisfied the inclusion criteria. Intervention was conducted during treatment in 8 studies, and after treatment in 5. Intervention duration ranged from 3 to 16 weeks, with 2 or 3 sessions per week, for a total of 9 to 36 sessions. All interventions were supervised; 12 were lab-based, and 1 was community-based. One of most promising outcomes was improvement of cardiorespiratory fitness by HIIT. Conclusion This review found that all studies on HIIT for breast cancer survivors investigated lab-based, supervised interventions, but not home-based or unsupervised. HIIT is a time-efficient method for increasing cardiovascular function in breast cancer survivors, but further research is necessary to determine its effects on other outcomes.
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Affiliation(s)
- Katsunori Tsuji
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan.
| | - Yutaka J Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Eisuke Ochi
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan. .,Faculty of Bioscience and Applied Chemistry, Hosei University, Tokyo, Japan.
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Lang AE, Kim SY, Dickerson CR, Milosavljevic S. Measurement of objective shoulder function following breast cancer surgery: a scoping review. PHYSICAL THERAPY REVIEWS 2020. [DOI: 10.1080/10833196.2020.1851439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Angelica E. Lang
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
| | - Soo Y. Kim
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, Canada
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8
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Siqueira TC, Frágoas SP, Pelegrini A, de Oliveira AR, da Luz CM. Factors associated with upper limb dysfunction in breast cancer survivors. Support Care Cancer 2020; 29:1933-1940. [PMID: 32808138 DOI: 10.1007/s00520-020-05668-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyze factors associated with upper limb dysfunction in women after breast cancer treatment. METHODOLOGY A cross-sectional study with 233 women over 18 years of age diagnosed with breast cancer and undergoing at least one cancer treatment (surgery and/or adjuvant treatment). Sociodemographic, anthropometric, and cancer treatment data were collected, as well as current physical and functional complications. Changes in breast tenderness and intercostobrachial nerve pathway, winged scapula, pain, cicatricial adherence, and lymphedema were evaluated by physical examination (inspection and palpation). Upper limb dysfunction was assessed using the DASH questionnaire. Chi-square test and logistic regression were used to verify possible associations between upper limb dysfunction and other variables. RESULTS The results showed that 55.4% of women had some level of upper limb dysfunction. Evaluating treatment conditions, lymphadenectomy, lymphedema, presence of pain, and intercostobrachial nerve injury were associated with some level of upper limb dysfunction in the crude analysis. The adjusted analysis showed that only upper limb dysfunction remained associated with intercostobrachial nerve injury, regardless of age and body mass index. CONCLUSION Upper limb dysfunction is frequent after breast cancer treatment and may be associated with neuropathies due to changes in the intercostobrachial nerve pathway.
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Affiliation(s)
- Thais Cristina Siqueira
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil
| | - Simone Pedrozo Frágoas
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil
| | - Andreia Pelegrini
- Human Movement Sciences Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Florianópolis, Brazil
| | - Ana Rosa de Oliveira
- Mastology Service, Carmela Dutra Maternity, Santa Catarina State Department of Health, Florianópolis, Brazil
| | - Clarissa Medeiros da Luz
- Physiotherapy Postgraduate Program, Health and Sports Science Center, Santa Catarina State University (UDESC), Pascoal Simone, 358, Coqueiros, Florianópolis, SC, 88080-350, Brazil.
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Paolucci T, Bernetti A, Bai AV, Segatori L, Monti M, Maggi G, Ippolitoni G, Tinelli L, Santilli V, Paoloni M, Agostini F, Mangone M. The sequelae of mastectomy and quadrantectomy with respect to the reaching movement in breast cancer survivors: evidence for an integrated rehabilitation protocol during oncological care. Support Care Cancer 2020; 29:899-908. [DOI: 10.1007/s00520-020-05567-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/05/2020] [Indexed: 01/05/2023]
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10
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Prieto-Gómez V, Navarro-Brazález B, Sánchez-Méndez Ó, de-la-Villa P, Sánchez-Sánchez B, Torres-Lacomba M. Electromyographic Analysis of Shoulder Neuromuscular Activity in Women Following Breast Cancer Treatment: A Cross-Sectional Descriptive Study. J Clin Med 2020; 9:jcm9061804. [PMID: 32531893 PMCID: PMC7355794 DOI: 10.3390/jcm9061804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
Certain secondary effects derived from medical treatment in breast cancer can favor the development of alterations in shoulder biomechanics. To the best of our knowledge, persistent peripheral pain as a key factor for the development of neuromuscular activity impairments has not been analyzed. A cross-sectional descriptive study was carried out. A total of 90 women were included and allocated to three groups: (i) 30 women with persistent peripheral pain after breast cancer treatment, (ii) 30 women without pain after breast cancer treatment, and (iii) 30 healthy women. Surface electromyography was employed to measure the onset and amplitude of the muscle activity of three shoulder movements. Statistically significant differences were found in the neuromuscular activity for all the muscles and shoulder movements among women with persistent pain versus healthy women (i.e., amplitude muscle activity variable p < 0.001). Statistically significant differences were also observed in the neuromuscular activity for certain muscles in shoulder movements among women with persistent pain versus women without pain, as well as between women without pain versus healthy women. Therefore, following breast cancer treatment, women showed alterations in their shoulder neuromuscular activity, which were more significant if persistent pain existed. These findings may contribute to developing a selective therapeutic exercise program that optimizes the shoulder neuromuscular activity in women after breast cancer treatment.
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Paolucci T, Bernetti A, Bai AV, Capobianco SV, Bonifacino A, Maggi G, Ippolitoni G, Tinelli L, Santilli V, Agostini F, Paoloni M, Mangone M. The recovery of reaching movement in breast cancer survivors: two different rehabilitative protocols in comparison. Eur J Phys Rehabil Med 2020; 57:137-147. [PMID: 32406224 DOI: 10.23736/s1973-9087.20.06138-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer in women in the developed world. The about the sequelae of surgery, especially in case of mastectomy or modified radical mastectomy is grown. Nowadays it is important choose appropriate exercise programs to allow recovery in "quantity" but also in "quality" of the movement of the operated upper limb. AIM The aim of this study was to verify whether specific exercises for the scapula may induce changes in fluidity of the reaching movement. DESIGN Randomized control-trial double-blind study. SETTING Exercise training laboratory and gait analysis laboratory. POPULATION Sixty-three breast cancer survivors were enrolled. METHODS Participants randomized to single rehabilitative treatment (ST), or to group rehabilitative treatment (GT). VAS, DASH and a biomechanical evaluation of upper limb were performed for each group before treatment (T0=baseline), at the end rehabilitative treatment (T1) and after three months of follow-up (T2). RESULTS Respect within group analysis, in the ST and in the GT, for VAS an improvement along evaluation times were observed, respectively at T0 to T1 and at T0 to T2 (P<0.001) without a statistically significant difference between groups. At the same, for the DASH, the results showed the same trend without a statistically significant difference between groups. For biomechanical parameters, at T2 velocity was statistically significantly greater in the ST than in the GT (P=0.029) in contrast with the duration, that was statistically significantly greater in the GT than in the ST (P=0.010). CONCLUSIONS Both protocols are effective in reducing pain and for functional recovery of the upper limb. The adoption of a non-intensive rehabilitation program should be implemented at least in the first year after the operation, with the adoption of specific myofascial exercises on the scapulo-thoracic joint with better results in the "qualitative" recovery of the achievement. CLINICAL REHABILITATION IMPACT Our study emphasizes the importance of rehabilitation in BC survivors after mastectomy, even during the course of radiotherapy and chemotherapy and the adoption of specific myofascial exercises on the scapulo-thoracic joint and specific exercises of muscular stretching on the pectoral muscle. Therefore, the proposed rehabilitation protocol must be "clipped" and "integrated" according to the specific objectives for each individual patient.
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Affiliation(s)
- Teresa Paolucci
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara, Pescara, Italy
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Arianna V Bai
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Serena V Capobianco
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | | | | | | | | | - Valter Santilli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy -
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
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Tokgöz S, Karaca Umay E, Yilmaz KB, Akkoca M, Akinci M, Azili C, Saydam M, Ucar Y, Balas Ş. Role of Intraoperative Nerve Monitoring in Postoperative Muscle and Nerve Function of Patients Undergoing Modified Radical Mastectomy. J INVEST SURG 2019; 34:703-710. [PMID: 31711327 DOI: 10.1080/08941939.2019.1684603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study aimed to postoperatively evaluate the effects of intraoperative neural monitoring (IONM) on muscles and nerves in patients who underwent modified radical mastectomy (MRM). In the 11 patients included in the study, nerves were determined and protected by nerve monitoring during the axillary dissection (IONM group). In another 11 patients, nerve monitoring was not performed; however, protection of the same nerves was attempted through careful nerve dissection (cautious nerve dissection [CND] group). The control group consisted of 22 healthy subjects. Muscle and nerve functions were blindly evaluated by an experienced physical therapy and rehabilitation specialist using electromyography (EMG) and ultrasonography (US) methods. The EMG values of the pectoralis major muscle were similar in the IONM and control groups (1.97 mV/1.98 mV, p = 0.97) but significantly lower in the CND group (1.57 mV, p < 0.05). Significant differences were found in the US values of the pectoralis major and minor muscles between the IONM and CND groups. No significant difference was found between the IONM and control groups in terms of EMG values of the serratus anterior muscle. This is the first prospective randomized study to objectively evaluate preservation of the nerve through nerve monitoring and its functional results. Monitoring of nerves during MRM is of great importance in terms of demonstrating the positive effects on muscle and nerve functions.
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Affiliation(s)
- Serhat Tokgöz
- Department of General Surgery, University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Ebru Karaca Umay
- Department of Physical Therapy and Rehabilitation, University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Kerim Bora Yilmaz
- Department of General Surgery, University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Muzaffer Akkoca
- Department of General Surgery, University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Melih Akinci
- Department of General Surgery, University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Cem Azili
- Department of General Surgery, University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Mehmet Saydam
- Department of General Surgery, University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Yasin Ucar
- Department of General Surgery, University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Şener Balas
- Department of General Surgery, University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
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13
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Ribeiro IL, Moreira RFC, Ferrari AV, Alburquerque-Sendín F, Camargo PR, Salvini TF. Effectiveness of early rehabilitation on range of motion, muscle strength and arm function after breast cancer surgery: a systematic review of randomized controlled trials. Clin Rehabil 2019; 33:1876-1886. [PMID: 31480855 DOI: 10.1177/0269215519873026] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective was to evaluate the effectiveness of early rehabilitation on arm range of motion (ROM), strength and function after breast cancer surgery (BCS). Data sources: PubMed, MEDLINE, Bireme, Embase, LILACS and CINAHL databases were searched. METHODS Two independent reviewers selected randomized controlled trials evaluating women who underwent early rehabilitation to restore arm ROM, strength or function after BCS. Cochrane Collaboration recommendations and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Methodological quality was assessed by the PEDro scale. The International Classification of Functioning, Disability and Health was considered to analyze results. Effect size (ES) was calculated for clinical relevance interpretation of the outcomes of interest, and the evidence was summarized through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Up to June 2019, a total of 1658 references were identified and 15 studies were included. Twelve of them presented adequate methodological quality. A total of 1710 patients were evaluated. Few studies performed the simultaneous assessment of variables related to body structure and function and patient-reported outcomes. A moderate level of evidence was synthesized regarding the effectiveness of ROM exercises for improving arm flexion, abduction and external rotation (ES: 0.45-2.5). A low level of evidence was synthesized regarding the effectiveness of isolated strengthening exercises for patient-reported arm function. ROM exercises associated with muscle strengthening exhibited a moderate level of evidence for improving shoulder flexion (ES: 1.4-2.4). CONCLUSION Both ROM and strengthening exercises associated with ROM exercises improved shoulder flexion, abduction and external rotation ROM after BCS. Shoulder abduction and external rotation showed less recovery, irrespective of the intervention applied.
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Affiliation(s)
- Ivana Leão Ribeiro
- Department of Kinesiology, Faculty of Health Sciences, Universidad Católica del Maule, Talca, Chile.,Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | | | | | - Francisco Alburquerque-Sendín
- Department of Socio-Sanitary Sciences, Radiology and Physical Medicine, Universidad de Córdoba, Córdoba, Spain.,Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Paula Rezende Camargo
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Tania Fátima Salvini
- Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, Brazil
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Puffer RC, Stone J, Spinner RJ. Avoidance of scapular winging while approaching tumors of the middle scalene region. Acta Neurochir (Wien) 2019; 161:1937-1942. [PMID: 31300885 DOI: 10.1007/s00701-019-04009-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Large tumors arising from the middle scalene region can displace the middle scalene muscle and distort regional anatomy, placing nerves at risk. Understanding the surgical anatomy of these nerves is key to approaching pathology of the middle scalene muscle and avoiding damage to the dorsal scapular, long thoracic, and spinal accessory nerves, each of which can cause scapular winging and associated morbidity if injured. METHODS IRB approval was obtained for this study, allowing cases with relevant pathology to be reviewed and presented to highlight the relevant surgical technique. Anatomical depictions were created to correlate intraoperative images with known anatomical relationships. RESULTS Key to this approach is consideration of the regional anatomy in a standard supraclavicular approach, the superficial plane, containing the anterior scalene muscle and brachial plexus, and the oblique plane containing the middle scalene muscle, long thoracic, spinal accessory, and dorsal scapular nerves. Identification and mobilization of each of these structures prior to lesion removal can not only provide likely boundaries of the tumor, but also allow for protection of the nerves to avoid injury that may lead to scapular winging with associated morbidity and functional impairment of the upper extremity. CONCLUSIONS Lesions of the middle scalene region often split two important anatomical planes, the superficial and deep, creating an advantageous surgical corridor through an anterolateral approach. Through early identification of known anatomy, these two planes can be developed, and a safe approach to the lesion of the middle scalene region can be exploited.
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Affiliation(s)
- Ross C Puffer
- Department of Neurosurgery, Mayo Clinic, 200 1st St, SW, Rochester, MN, 55905, USA.
| | - Jonathan Stone
- Department of Neurosurgery, Mayo Clinic, 200 1st St, SW, Rochester, MN, 55905, USA
| | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, 200 1st St, SW, Rochester, MN, 55905, USA
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Physical symptoms and components of labor tasks associated with upper limb disability among working breast cancer survivors. Breast Cancer 2019; 27:140-146. [DOI: 10.1007/s12282-019-01004-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
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Marazzi F, Masiello V, Marchesano D, Boldrini L, Luzi S, Ferrara PE, Amabile E, Piccari D, Landi F, Moschella F, Franceschini G, Masetti R, Mantini G, Valentini V, Smaniotto D. Shoulder girdle impairment in breast cancer survivors: the role of range of motion as predictive factor for dose distribution and clinical outcome. TUMORI JOURNAL 2019; 105:319-330. [DOI: 10.1177/0300891619839287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background:Pain and functional impairment of the ipsilateral shoulder girdle in patients who underwent surgery and radiotherapy for breast cancer (BC) is a late complication reported in the literature. We analyze a correlation with dosimetric parameters and propose an algorithm for sparing strategies.Methods:A total of 111 patients treated for BC were included in this observational analysis during follow-up protocol visits. Exclusion criteria were the presence of moderate or severe arthrosis history and/or rheumatologic diseases. All the patients had complete physical and multidimensional examinations during joint (physiatrist and radiotherapy oncology) follow-up visits. A scapula–humeral articulation (SHA) standardized contouring was performed retrospectively on Eclipse® treatment plans. A possible correlation between patients’ characteristics, radiotherapy, and dosimetry analysis and functional impairment was investigated at statistical analysis. Results of analysis were summarized into a proposal of algorithm for sparing SHA.Results:A total of 111 patients were selected during follow-up visits. Mean age of patients was 60 years (range 41–85 years). A total of 103 patients (93%) underwent conservative surgery, with 110 patients (99%) undergoing axilla surgery as well. Fifty-two patients (46.8%) presented a reduction of range of motion (ROM) abduction on the treated side at the observational analysis. Mean ROM abduction reduction was 13°06’ (range 0°–100°). Disability of the Arm, Shoulder and Hand questionnaire (DASH) score results were excellent in 79 patients (71.2%), discrete in 15 patients (13.5%), good in 15 patients (13.5%), and sufficient in 2 patients (1.8%). Median EQD2Dmaxat SHA was 18 Gy (range 0.22–51.9 Gy) and median EQD2mean dose at SHA was 2 Gy (range 0.04–24.32 Gy). Univariate analysis showed a linear correlation between DASH score and ROM of abduction of treated side (ρ=−0.7), ROM of abduction and ROM of flexion in ipsilateral arm (ρ=0.8), or ROM of abduction and ROM of flexion in contralateral arm (ρ=0.8). A statistically significant difference in ROM abduction between the 2 arms was found at χ2test ( P<0.05 at χ2confidence interval = 95%). Cox linear regression analysis showed ROM abduction on treated arm as a predictive factor of DASH score ( P<0.0001). Age ( P<0.05), DASH score ( P=0.006), and ROM abduction on treated arm ( P=0.005) were found as independent predictive factors of mean dose at multivariate analysis. A mean dose higher than 7 Gy and ROM abduction reduction more than 30° were related to DASH score level reduction.Conclusions:This hypothesis-generating study introduces an algorithm to be validated for management of sparing SHA and improving quality of survivorship. ROM evaluation after surgery, early physiotherapy, standard contouring, and planning adaptation represent possible indications to preserve shoulder impairment. Further prospective studies are needed to discriminate impairment of surgery and radiotherapy in order to personalized therapeutic plan programs.
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Affiliation(s)
- Fabio Marazzi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Valeria Masiello
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Domenico Marchesano
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Luca Boldrini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Stefano Luzi
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
| | - Paola E. Ferrara
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Riabilitazione e Medicina Fisica, Dipartimento di Scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Roma, Italia
| | - Eugenia Amabile
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Riabilitazione e Medicina Fisica, Dipartimento di Scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Roma, Italia
| | - Danila Piccari
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
| | - Francesco Landi
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Riabilitazione e Medicina Fisica, Dipartimento di Scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Roma, Italia
| | - Francesca Moschella
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia
| | - Gianluca Franceschini
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia
| | - Riccardo Masetti
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Chirurgia Senologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italia
| | - Giovanna Mantini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
| | - Vincenzo Valentini
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
| | - Daniela Smaniotto
- Fondazione Policlinico Universitario “A. Gemelli” IRCCS, UOC di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italia
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italia
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Three-dimensional scapular kinematics, shoulder outcome measures and quality of life following treatment for breast cancer - A case control study. Musculoskelet Sci Pract 2019; 40:72-79. [PMID: 30711913 DOI: 10.1016/j.msksp.2019.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are no conclusive results concerning changes in scapular kinematics associated with upper limb dysfunctions after breast cancer surgery. OBJECTIVE To compare the three-dimensional (3-D) scapular kinematics during elevation of the arm between women after breast cancer surgery and controls. Shoulder range of motion (ROM), muscle strength, pain intensity, upper limb function, and quality of life were also assessed. METHODS Forty-two women were assigned to two groups (surgery group, n = 21; control group, n = 21). 3-D scapular kinematics was collected during elevation of the arm in the scapular plane. ROM was assessed using a digital inclinometer, muscle strength using a manual dynamometer, pain with the Visual Analogue Scale (VAS), upper limb function with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and quality of life with the 36-item Short-Form Health Survey (SF36). RESULTS The surgery group presented decreased scapular upward rotation at 120° of arm elevation in the scapular plane (p < .05; d = -0.88), decreased shoulder external rotation ROM and strength of shoulder abduction and external rotation when the affected side was compared to the non-affected side and control group. Moreover, the surgery group also reported higher pain, increased upper limb disability and poorer quality of life compared with healthy controls. CONCLUSION Scapular upward rotation seems to be decreased at 120° of arm elevation in women following breast cancer surgery. In addition, shoulder external rotation ROM, abduction strength, external rotation strength, function, and quality of life are also impaired in these women. They also experienced pain during the studied movements.
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Akkoca M, Ateş MP, Yılmaz KB, İmamoğlu İ, Balas Ş, Tokgöz S, Akıncı M, Karabacak H, Ünlü E. The effect of lateral pectoral nerve sparing technique and radiotherapy on the pectoralis major muscle applied with modified radical mastectomy. Asian J Surg 2018; 42:501-506. [PMID: 30268639 DOI: 10.1016/j.asjsur.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/14/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to evaluate with electromyography (EMG) the effect of lateral pectoral nerve sparing technique (LPNST) and radiotherapy (RT) on the lateral pectoral nerve (LPN) in patients applied with modified radical mastectomy (MRM). METHODS The study included 66 patients who underwent MRM surgery. The patients were separated into 2 groups as those applied with LPNST and those who underwent standard surgery (Control group). Within these 2 groups, patients were again separated as those who received or did not receive RT. The EMG evaluations were made by a neurology specialist blinded to the patient groups. RESULTS The mean age of the patients was 53.3 ± 10.6 years. Standard surgery was applied to 33 (50%) patients and LPNST to 33 (50%) patients, RT was applied to 32 (48.5%) patients and not to 34 (51.5%) patients. In the EMG evaluation, latency was 2.1 ms (1.4-3.2) in the LPNST and 3.7 ms (1.9-12.4) in the control (p <0.001) and amplitude values were 9650 mV (3120-36900) in the LPNST and 4780 mV (510-12.4) in the control (p <0.001). The latency values in the Control receiving and not receiving RT were 4.0 ms (1.9-12.4) and 2.6 ms (1.9-6.2) respectively (p <0.05). The latency values of the patients receiving and not receiving RT in the LPNST were 2.2 ms (1.8-3.2) and 2.0 ms (1.4-2.4) respectively (p <0.05). In the Control and LPNST Group, no significant difference was determined between receiving and not receiving RT groups in respect of amplitude values (p >0.05). CONCLUSION The results of this study demonstrated that electromyographically the latency and amplitude values were better protected in the LPNST group. It was also seen that RT increased the formation of nerve damage in both groups.
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Affiliation(s)
- Muzaffer Akkoca
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey.
| | - Mehlika Panpallı Ateş
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Neurology, Ankara, Turkey
| | - Kerim Bora Yılmaz
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - İnanç İmamoğlu
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Medical Oncology, Ankara, Turkey
| | - Şener Balas
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Serhat Tokgöz
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Melih Akıncı
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Harun Karabacak
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Ece Ünlü
- University of Health Science, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Department of Physical Therapy and Rehabilitation, Ankara, Turkey
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Lozano-Lozano M, Martín-Martín L, Galiano-Castillo N, Álvarez-Salvago F, Cantarero-Villanueva I, Fernández-Lao C, Sánchez-Salado C, Arroyo-Morales M. Integral strategy to supportive care in breast cancer survivors through occupational therapy and a m-health system: design of a randomized clinical trial. BMC Med Inform Decis Mak 2016; 16:150. [PMID: 27887610 PMCID: PMC5124301 DOI: 10.1186/s12911-016-0394-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/22/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Technological support using e-health mobile applications (m-health) is a promising strategy to improve the adherence to healthy lifestyles in breast cancer survivors (excess in energy intake or low physical activity are determinants of the risk of recurrence, second cancers and cancer mortality). Moreover, cancer rehabilitation programs supervised by health professionals are needed due to the inherent characteristics of these breast cancer patients. Our main objective is to compare the clinical efficacy of a m-health lifestyle intervention system alone versus an integral strategy to improve Quality of Life in breast cancer survivors. METHODS This therapeutic superiority study will use a two-arm, assessor blinded parallel RCT design. Women will be eligible if: they are diagnosed of stage I, II or III-A breast cancer; are between 25 and 75 years old; have a Body Mass Index > 25 kg/m2; they have basic ability to use mobile apps; they had completed adjuvant therapy except for hormone therapy; and they have some functional shoulder limitations. Participants will be randomized to one of the following groups: integral group will use a mobile application (BENECA APP) and will receive a face-to-face rehabilitation (8-weeks); m-health group will use the BENECA app for 2-months and will received usual care information. Study endpoints will be assessed after 8 weeks and 6 months. The primary outcome will be Quality of Life measured by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core and breast module. The secondary outcomes: body composition; upper-body functionality (handgrip, Disability of the Arm, Shoulder and Hand questionnaire, goniometry); cognitive function (Wechsler Adult Intelligence Scale, Trail Making Test); anxiety and depression (Hospital Anxiety and Depression Scale); physical fitness (Short version of the Minnesota Leisure Time Physical Activity Questionnaire, Self-Efficacy Scale for Physical Activity); accelerometry and lymphedema. DISCUSSION This study has been designed to seek to address the new needs for support and treatment of breast cancer survivors, reflecting the emerging need to merge new low cost treatment options with much-needed involvement of health professionals in this type of patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02817724 (date of registration: 22/06/2016).
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Affiliation(s)
- Mario Lozano-Lozano
- Department Physical Therapy, University of Granada, Granada, Spain.,Mixed University Sport and Health Institute (iMUDS), Granada, Spain
| | | | - Noelia Galiano-Castillo
- Department Physical Therapy, University of Granada, Granada, Spain.,Institute for Biomedical Research ibs.GRANADA, University Hospital Complex of Granada/ University of Granada, Granada, Spain
| | | | - Irene Cantarero-Villanueva
- Department Physical Therapy, University of Granada, Granada, Spain.,Mixed University Sport and Health Institute (iMUDS), Granada, Spain.,Institute for Biomedical Research ibs.GRANADA, University Hospital Complex of Granada/ University of Granada, Granada, Spain
| | - Carolina Fernández-Lao
- Department Physical Therapy, University of Granada, Granada, Spain.,Mixed University Sport and Health Institute (iMUDS), Granada, Spain.,Institute for Biomedical Research ibs.GRANADA, University Hospital Complex of Granada/ University of Granada, Granada, Spain
| | | | - Manuel Arroyo-Morales
- Department Physical Therapy, University of Granada, Granada, Spain. .,Mixed University Sport and Health Institute (iMUDS), Granada, Spain. .,Institute for Biomedical Research ibs.GRANADA, University Hospital Complex of Granada/ University of Granada, Granada, Spain.
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