Shoulder physiotherapy helpful after axillary dissection in breast cancer

NEW YORK (Reuters Health) – Women who experience shoulder pain and reduced arm or shoulder function after breast cancer surgery and axillary lymph node dissection may benefit from physiotherapy, clinicians from the Netherlands report in the online journal BMC-Cancer.

"Unrelated to breast cancer, there is a high prevalence (7%-36%) of musculoskeletal shoulder disorders in the population resulting in considerable pain and disability," Dr. Carien H. G. Beurskens from Radbound University Nijmegen Medical Centre and colleagues note in their report. "Physiotherapy is often the first choice of treatment and has been proven to be effective for these shoulder disorders."

However, data are lacking on the value of physiotherapy for shoulder complaints related to breast cancer and axillary node dissection.

To investigate, Dr. Beurskens’ team randomly assigned 30 women with shoulder complaints following the surgery to physiotherapy, with soft tissue massage to the surgical scar if needed, or a control group. Physiotherapy, which started two weeks after surgery, consisted of nine sessions given within three months. The control group had no physiotherapy, receiving only a leaflet flyer with advice and arm/shoulder exercises.

After three and six months, the physiotherapy group showed a "significant improvement in shoulder mobility and had significantly less pain than the control group," the authors report. Quality of life also improved significantly in women who had physiotherapy, and there was a positive trend toward improved handgrip strength. However, arm volume showed little change with edema commonly occurring at a later stage after surgery.

Before physiotherapy, most women indicated that they avoided social activities and this "improved greatly following therapy," Dr. Beurskens and colleagues report.

"Based on our current findings, we argue that patients with shoulder complaints after axillary lymph node dissection should be referred to a physiotherapist." The researchers also recommend a functional shoulder assessment by a physiotherapist at the first outpatient visit two weeks following breast cancer surgery and axillary lymph node dissection.

BMC-Cancer 2007;7.