Exercise Protocol With Limited Shoulder Range of Motion for 15 or 30 Days After Conservative Surgery for Breast Cancer With Oncoplastic Technique: A Randomized Clinical Trial.

OBJECTIVE: The objective is to evaluate the effect of limiting shoulder range of motion (ROM) for 15 or 30 days on surgical complications and on shoulder ROM, pain, and upper limb function of breast cancer patients following conservative oncoplastic surgery. MATERIALS AND METHODS: A randomized clinical trial was conducted with 60 women with breast cancer who underwent conservative oncoplastic surgery. The day after surgery, all patients started an exercise protocol with shoulder exercises limited to 90 degrees. Two weeks after surgery they were randomized into Free ROM Group (n=30) or Limited ROM Group (n=30). The Free ROM Group was allowed to perform shoulder exercises with unlimited ROM; the Limited ROM Group continued with shoulder movement restricted at 90 degrees until 30 days after surgery, at which time they were also allowed free ROM. The primary outcome was the incidence of postoperative complications (dehiscence, seroma, infection, and necrosis) and secondary outcomes were shoulder ROM, pain, and upper limb function. RESULTS: No difference in the incidence of postoperative scar complications between groups was noted. There was no difference between the groups in shoulder joint amplitude, pain, or upper limb function. CONCLUSIONS: The free ROM exercise protocol 15 days post surgery was safe concerning cicatricial complications.

Diagnosis of Axillary Web Syndrome in Patients After Breast Cancer Surgery: Epidemiology, Risk Factors, and Clinical Aspects: A Prospective Study.

OBJECTIVES: Axillary web syndrome (AWS) is a complication after breast cancer surgery associated with the axillary approach. We defined a diagnosis tool as well as evaluated cord frequency, characteristics, and risk factors. METHODS: A prospective cohort study of 173 women followed-up at Breast Diseases Division of Universidade Federal de São Paulo between July 2014 and September 2015 was established as an evaluation protocol to diagnose AWS. Sociodemographic status, anthropometric values, range of motion, comorbidities, pain, cord frequency, and characteristics (localization, number, palpable, and/or visible) among other data were collected at different time points before and after surgery. RESULTS: The majority of the cords appeared by the seventh day (66.1%), and the total incidence of the cords was 90.9% at the 180th day. The axilla was the place for 80% of the occurrence of AWS, and >70% of the cords were palpable. Flexion and abduction of the shoulder showed reduced range of motion. Pain was present in 39.7% of the patients. Lymphadenectomy as well as hypertension were associated with increased risk of cord development; diabetes was associated with a decreased risk. CONCLUSIONS: The evaluation protocol applied here showed a high incidence of AWS, with palpable cords more frequent than visible ones. The significance of hypertension and diabetes mellitus as risk factors for cord development in AWS should be evaluated in future studies. The evaluation protocol developed in this study seems to be of great importance for early detection of AWS and could also be valuable for future treatment planning.