Barriers to rehabilitation following surgery for primary breast cancer

ArticleinJournal of Surgical Oncology 95(5):409-18 · April 2007with54 Reads
DOI: 10.1002/jso.20782 · Source: PubMed
Abstract
Surgery is a mainstay of primary breast cancer therapy. Alterations in surgical technique have reduced normal tissue injury, yet pain and functional compromise continue to occur following treatment. A tenuous evidence base bolstered by considerable expert opinion suggests that early intervention with conventional rehabilitative modalities can reduce surgery-associated pain and dysfunction. Barriers to the timely rehabilitation of functionally morbid sequelae are discussed at length in this article. Barriers arise from a wide range of academic, human, logistic, and financial sources. Despite obstacles, expeditious and effective post-surgical rehabilitation is being regularly delivered to breast cancer patients at many institutions. This experience has given rise to anecdotal information on the management of common sequelae that may undermine function. The epidemiology, pathophysiology, and management of these sequelae are outlined in this article with an emphasis on the caliber of supporting evidence. Myofascial dysfunction, axillary web syndrome, frozen shoulder, lymphostasis, post-mastectomy syndrome, and donor site morbidity following breast reconstruction are addressed. A critical need for more definitive evidence to guide patient management characterizes the current treatment algorithms for surgical sequelae.
    • "Axillary web syndrome (AWS) has been reported as a sequelae following breast cancer surgery with patients demonstrating tightness of the axilla and chest wall, a protracted shoulder on the side of surgery, decreased shoulder abduction and referred arm pain to the wrist, and associated thoracic kyphosis (Lacomba et al., 2010) (Kepics, 2004;Lacomba et al., 2010). AWS is accompanied by adhesions and the treatment is similar to that of chest wall adhesions (Cheville and Tchou, 2007;Crawford et al., 1996;Kepics, 2004;Smoot et al., 2010). Other causes of chest wall adhesions have been reported in the literature. "
    [Show abstract] [Hide abstract] ABSTRACT: The Upper Crossed Syndrome (UCS) was presented by Janda to introduce neuromotor aspects of upper body muscle imbalances, describing sagittal plane postural asymmetries as barriers to recovery from chronic locomotor system pain syndromes. The UCS describes muscle imbalances of key antagonists causing forward postures of the head and shoulders and associated changes in the spinal curves -particularly an increased thoracic kyphosis - as well as changed function in the shoulder girdle. The role of fascial tissue has gained remarkable interest over the past decade, previously emphasizing its anatomic compartmental and binding role, while more recently emphasizing load transfer, sensory and kinetic chain function. The authors introduce the Mid-Pectoral Fascial Lesion (MPFL) as a myofascial disorder, describing 11 ipsilateral chest wall cases. While managing these cases, the authors encountered and subsequently designated the Torsional Upper Crossed Syndrome (TUCS) as a multi-planar addition to Janda's classic sagittal plane model.This article integrates published updates regarding the role of posture and fascia with the effects of chest wall trauma and a newly described associated postural syndrome as illustrated with this case series. An effective therapeutic approach to release the MPFL is then briefly described.
    Article · Aug 2015
    • "@BULLET Chemo therapy can induce a toxic poly neuritis that changes the properties of the nerve fiber, causing burning pain, localized dysesthesia in the limbs; @BULLET tumoral and iatrogenic Injuries of the central nervous system, Rehabilitation of cancer pain in lung cancer: role of manual therapy immobilization with myofascial and ligaments syndromes of the affected joints, reflex sympathetic dystrophy; Herpes Zoester, Candida albicans; paraneoplastic syndromes.[14][15]Breast cancer patients may develop chronic postsurgical pain following breast cancer treatment Risk factors for acute pain and its persistence following breast cancer surgery (Macrae, 2001)[16]and thus adopt specific protective postures resulting in muscle spasm and muscle imbalances (Cheville & Tchou, 2007)[17]. Growing evidence is being produced in support for the use of rehabilithation training in head and neck cancer patients, in order to manage shoulder dysfunction and pain secondary to spinal accessory nerve damage. The importance of correcting posture and scapular stability prior to resistance exercise has been documented byMcNeely et al (2004).[18]The "
    Full-text · Article · Jan 2015
    • "Therapeutic approaches of manual therapy include the use of simple muscle stretching, post-isometric relaxation , reciprocal inhibition, slow exhalation, eye movements , pressure release trigger point massage, range of motion, heat, ultrasound, galvanic stimulation of high voltage , drug treatment and biofeedback. (8) Notably, anxiety and pain as well as shoulder capsular approaches may favor the onset of dysfunction and myofascial trigger point formation in mastectomy patients.(9)Due to the high rate of breast cancer, come to affect women at an increasingly younger age group generating physical, social and emotional changes, the manual therapy is being increasingly used as a new form of treat- ment. "
    [Show abstract] [Hide abstract] ABSTRACT: Cancer is now the third leading cause of death in the world, surpassed only by accidents and cardiovascular deaths by external causes, among them stands mammary carcinoma. Mastectomy is in a procedure consisting of invasive breast removal due to some anatomical and functional changes previously diagnosed. With the growth of the disease and its high content in increasingly young women, Manual Therapy has been used as a new form of treatment. Objective: To show the effects of manual therapy in patients after mastectomy surgery. Method: This was a systematic review study in which secondary and tertiary sources were used, using the databases PubMed, Medline, Lilacs and SciELO. It was adopted as inclusion criteria studies classified as: a randomized controlled trial, with publication period between 2009 and 2013. Were used as search terms: "Mastectomy", "Neck", "Shoulder Pain", "Musculoskeletal Manipulations" and "Functionality". Results: Among the 37 initially selected by electronic search in the databases of articles, 25 were excluded for the title did not meet the inclusion criteria. Of the 12 retained studies, 5 were excluded for duplicity. 7 studies were selected for a more thorough analysis through summary, 2 of them being excluded. The remaining 5 articles were evaluated from reading the text. It can be seen that the manual therapy techniques have significant results in the alleviation of muscle pain in patients submitted to surgery mastectomia. Conclusion: It can be seen that the manual therapy techniques have significant results in the alleviation of muscle pain in patients undergoing the mastectomy surgery. However, there is still a lack of studies of type randomized controlled trial on the effects of manual therapy in patients in the postoperative period of mastectomy
    Full-text · Article · Sep 2014
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