Goniometric analysis of affected joints in axillary, inguinal or ilioinguinal lymphadenectomies for the treatment of cutaneous melanoma

ABSTRACT

Objectives: The objective of this study is to compare the joint range of motion (ROM) reduction between the submitted limb to lymphadenectomy and contralateral and to evaluate if ROM restriction is also connected with lymphedema. Materials and Methods: Evaluated were 84 patients submitted to axillary lymphadenectomy (n=40), inguinal (21) or ilioinguinal (23) for the treatment of cutaneous melanoma, operated between 1990 and 2008. Individuals excluded were those with amputation of a limb or bilateral dissection that would make perimetry and goniometry comparison impossible. The invited patients were submitted to goniometric evaluation of the shoulder or hip and measurement of the upper or lower limbs through manual perimetry. Results: The difference of 4.2 degrees between the averages of ROM flexion (p=0.005) of the shoulder of the affected side in relation to the control, and 5.2 degrees in abduction (p=0.002) were sufficient to be statistically significant, with the exception of 3 degrees of external rotation (p=0.135). The differences between the means of hip ROM were also significant, varying 8.5 degrees in flexion (p <0.001) and 2.2 degrees in abduction (p=0.011). The ROM of the shoulder or hip of the affected side did not present differences between the 33 patients with lymphedema in relation to the 51 patients without lymphedema: shoulder with flexion (p=0.148), abduction (p=0.577) and external rotation (p=0.866); hip with flexion (p = 0.665) and abduction (p=0.795). Conclusion: In spite of individuals with lymphadenectomy show restriction of joint ROM in flexion and abduction of the shoulder and hip in the late postoperative period, there was no association between joint ROM, of the shoulder on both the hip and the presence of lymphedema.