1. Immediate versus delayed shoulder exercises after axillary lymph node dissection
- Author
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Jansen, Ruud F.M., van Geel, Albert N., de Groot, Hans G.W., Rottier, Atto B., Olthuis, Gerard A.A., and van Putten, Wim L.J.
- Subjects
Physical therapy -- Evaluation ,Breast cancer ,Mastectomy -- Complications ,Lymph nodes ,Health - Abstract
A total of 144 evaluable patients with breast cancer were enrolled in a multicenter, randomized, prospective study to establish the role of delayed shoulder exercises on wound drainage and shoulder function after axillary lymph node dissection. Patients in group 1 (n = 78) started active shoulder exercises 1 day postoperatively. Patients in group 2 (n = 66) started on the eight postoperative day, following 1 week of immobilization of the arm. Patients in group 2 had 14% less wound drainage volume than those in group 1 (600 [+ or -] 436 mL versus 701 [+ or -] 398 mL); this difference, however, was not significant. Also, no differences could be established between the two groups when duration and volume of wound drainage, number and volume of wound drainage, number and volume of seroma aspirations, would complication rates, and shoulder function were compared 6 months after surgery., The most common cancer in women is breast cancer, occurring in about 9 percent of the female population. Treatment for this cancer may include breast resection (removal of all or a significant portion of the breast) and dissection of the lymph nodes of the axilla (arm pit). The most common postoperative complication is development of lymphedema (accumulation of lymph in the soft tissues); inadequate function of the shoulder may also result. Postoperative care for these complications is controversial. Some physicians recommend shoulder exercises immediately after surgery, but others suggest that these early exercises reduce the desired drainage from the wound. In order to evaluate the effects of early exercise, a prospective randomized study was undertaken of 144 patients with breast cancer. All patients, those having modified radical mastectomy as well as those having breast conserving treatment, underwent axillary lymph node dissection. One group of 78 women began active shoulder exercises one day following surgery; the second group, 66 women, began exercises on the eighth postoperative day. Shoulder function was measured at the time of discharge and then at one and six months after surgery. Comparison of the two groups at six months revealed no difference in the duration and volume of wound drainage, wound complication rates or shoulder function. It is concluded that early or delayed shoulder exercise does not influence the outcome in terms of shoulder function in women after surgery for breast cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)
- Published
- 1990