Shoulder Strength Changes One Year after Axillary Lymph Node Dissection or Sentinel Lymph Node Biopsy in Breast Cancer Patients

Publication date: Available online 4 January 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Sandra Monleon, Montse Ferrer, Marta Tejero, Roser Belmonte
ObjectiveTo assess the changes in shoulder strength of breast cancer patients during the first year after surgery; and to compare the effect of sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) on shoulder strength.DesignProspective longitudinal observational study from pre-surgery to one year after.SettingTertiary hospital.ParticipantsOf 129 consecutive patients examined for eligibility, a sample of 112 women with breast cancer were included (44 underwent ALND and 68 SLNB).Main outcomes measuresDifference between the affected and the unaffected arm in strength of shoulder external rotators, internal rotators, abductors and serratus anterior, measured by dynamometry. Evaluations were performed prior to surgery and at 1, 6 and 12 months after surgery.ResultsAfter breast cancer ALND surgery, strength decreased significantly at the first month for internal rotators, without having recovered pre-surgery values after one year of follow-up with a mean difference of 2.26 Kg (p=0.011). There was no significant loss of strength for patients treated with SLNB. The loss of shoulder range of motion was only significant the first month for the ALND group. The factors identified as associated with strength loss in the General Estimating Equation Models were the ALND surgery and having received physical/occupational therapy during follow-up.ConclusionsOne year after breast cancer surgery, patients treated with ALND had not recovered their previous shoulder internal rotators strength, while those who underwent SLNB presented no significant loss of strength. This provides important information for designing rehabilitation programs targeted specifically at the affected muscle group after nodal surgical approach.



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