Scientific paper
Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer

https://doi.org/10.1016/S0002-9610(02)01214-XGet rights and content

Abstract

Background

We evaluated the prevalence of motion restriction and axillary web syndrome (AWS) after sentinel node biopsy (SNB) and axillary clearance (AC) in a prospective study. AWS is a self-limiting cause of early postoperative morbidity after axillary surgery. Limited range of motion associated with palpable cords of tissue in the axilla are typical for AWS.

Methods

Altogether 85 breast cancer patients who underwent SNB only (49 patients) or SNB and AC (36 patients) were examined before and after surgery. The range of shoulder flexion and abduction and the presence of AWS were registered.

Results

The range of shoulder movements was restricted in 24 (45%) patients after SNB only and in 31 (86%) patients who also underwent AC (P = 0.002). AWS was encountered in 10 (20%) patients with SNB and in 26 (72%) with AC (P <0.00005).

Conclusions

In the SNB group, significantly less early postoperative morbidity was observed.

Section snippets

Patients and methods

Altogether 109 patients with clinical T1-T2 axillary node negative breast cancer underwent lymphatic mapping and SNB from January 30 to June 21, 2001, at Maria Hospital, the Breast Surgery Unit of Helsinki University Hospital. Eighty-five patients were examined the day before and 2 weeks as well as 3 months after surgery by a physiotherapist and were included in a prospective study. The characteristics of the 85 study patients are presented in Table 1. Twenty-four patients were excluded,

Results

The range of shoulder abduction and flexion was restricted 2 weeks after operation compared with the preoperative measurement in 24 of 49 (45%) patients with SNB only and in 31 of 36 (86%) patients who underwent AC also(P = 0.002). In addition, 15 patients in the SNB group and 5 patients in the AC group suffered from subjective feelings of restricted movements despite of full range of shoulder flexion and abduction. The reasons for restricted movements were AWS and pain or strain in the wound,

Comments

The major finding in this prospective study was that patients who underwent SNB without further axillary treatment recovered from breast cancer surgery with significantly less early postoperative morbidity than those who underwent AC also. The findings of a few previous studies indicate significantly less or even negligible postoperative pain, numbness, motion restriction or lymphedema after SNB compared with AC [5], [6], [7], [8]. To our knowledge, this is the first study evaluating motion

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