Early Free Range-of-Motion Upper Limb Exercises After Mastectomy and Immediate Implant-Based Reconstruction Are Safe and Beneficial: A Randomized Trial.

BACKGROUND: This study assessed the impact that free range-of-motion (ROM) upper limb exercises 15 or 30 days after mastectomy and immediate implant-based reconstruction has on surgical complications and kinetic-functional recovery. METHODS: This randomized clinical trial included 60 women who had breast cancer treated with mastectomy and immediate implant or tissue expander reconstruction. The patients initiated the exercises with shoulder ROM limited to 90° the day after surgery. After 2 weeks, the patients were randomized into two groups of 30 patients each: the "free-range group," which permitted shoulder range exercises until limited by pain or wound dehiscence, and the "limited-range group," which maintained shoulder movement restriction at 90° until 30 days after surgery, at which time they also were allowed to perform free-range exercises. The patients underwent evaluations preoperatively, then 7, 15, 30, 60, and 90 days after surgery. The primary outcomes were incidence and prevalence of dehiscence and seroma and incidence of infection and necrosis. The secondary outcomes were shoulder ROM, pain, and upper limb function. RESULTS: The two groups did not differ in terms of incidence and prevalence of postoperative complications. The patients with free upper limb exercise 15 days after surgery had less pain, greater shoulder amplitude, and better upper limb function than those who had movement restricted to 90° for 30 days. CONCLUSION: The postoperative protocol with free shoulder ROM on the 15th day after surgery is safe and beneficial in terms of kinetic-functional recovery and pain control for patients after mastectomy and immediate implant-based reconstruction. CLINICAL TRIALS REGISTER: NCT02480842.

Terapia física complexa no tratamento do linfedema maligno / Complex physiotherapy in the tratament of malignant lymphedema

O linfedema de membro superior é uma complicação frequente após tratamento do câncer de mama. Quando há recidiva do tumor ou crescimento tumoral desconhecido que gera infiltração ou compressão da rede linfática, pode ocorrer o desenvolvimento do linfedema maligno. O objetivo terapêutico para o linfedema maligno é estabilizar a doença e mantê-la assintomática. A fisioterapia pode auxiliar no tratamento por meio da técnica denominada "terapia física complexa". O presente estudo aborda o caso de uma paciente de 61 anos pós-tratamento de câncer de mama diagnosticada com linfedema maligno no membro superior esquerdo. A equipe de fisioterapia utilizou a terapia física complexa para redução e controle do linfedema no membro superior afetado e obteve valores expressivos na diminuição do volume em relação à avaliação inicial e ao final do tratamento, ainda, não houve retrocesso a valores iniciais após período de 3 meses de seguimento. (AU)

Upper limb lymphedema is a frequent complication following breast cancer treatment. When there is tumor relapse, or unknown tumor growth that leads to lymph nodes compression or infiltration, the development of malignant lymphedema can take place. The therapeutic goal for malignant lymphedema is to stabilize the disease, and keep it asymptomatic. Physical therapy can help in the treatment through the technique called "complex physical therapy". The present study deals with the case of a 61-year-old patient after treatment of breast cancer diagnosed with malignant lymphedema in the left upper limb. The physiotherapy team used complex physical therapy to reduce and control the upper limb lymphoedema, and obtained significant values in volume reduction at the end of treatment compared to baseline, and no reversal to initial values after a 3-month follow up was observed. (AU)

Evaluation of body image, quality of life, tactile sensitivity and pain in women with breast cancer submitted to surgical intervention.

OBJECTIVE: Breast cancer is one of the most common types of tumor in the world and the most common among women. There are several treatments for breast cancer; however, the condition often can be accompanied by severe complications in a woman's life. To evaluate and compare body image perception, quality of life, tenderness, and pain in women with breast cancer during preoperative and postoperative periods of 30, 60 and 90 days. MATERIALS AND METHODS: We conducted a prospective longitudinal study. The patients answered the questionnaire "How I relate to my own body", EORTC QLQ-C30 and EORTC QLQ-BR23. We assessed upper limb and breast sensitivity with an esthesiometer. Patients were questioned about the presence and level of pain on a scale of 0 to 10. RESULTS: For body image, it was possible to observe a significant difference between pre and postoperative at 30 days. There were changes in some areas of the EORTC QLQ C30 and EORTC QLQ BR23 questionnaires, such as arm and breast symptoms, social function, constipation, sexual function and satisfaction, among others. For evaluation of breast and axilla sensitivity and assessment of pain, all postoperative periods showed significant differences when compared to the preoperative period. The sensitivity of the inner region of the arm presented no significant change. CONCLUSION: The difference found in the study shows that evaluations on all scales should be done in several periods, using a proper treatment for the changes and individuality of each patient.

Evaluation of body image, quality of life, tactile sensitivity and pain in women with breast cancer submitted to surgical intervention

SUMMARY Breast cancer is one of the most common types of tumor in the world and the most common among women. There are several treatments for breast cancer; however, the condition often can be accompanied by severe complications in a woman's life. OBJECTIVE: o evaluate and compare body image perception, quality of life, tenderness, and pain in women with breast cancer during preoperative and postoperative periods of 30, 60 and 90 days. MATERIALS AND METHODS: We conducted a prospective longitudinal study. The patients answered the questionnaire "How I relate to my own body", EORTC QLQ-C30 and EORTC QLQ-BR23. We assessed upper limb and breast sensitivity with an esthesiometer. Patients were questioned about the presence and level of pain on a scale of 0 to 10. RESULTS: For body image, it was possible to observe a significant difference between pre and postoperative at 30 days. There were changes in some areas of the EORTC QLQ C30 and EORTC QLQ BR23 questionnaires, such as arm and breast symptoms, social function, constipation, sexual function and satisfaction, among others. For evaluation of breast and axilla sensitivity and assessment of pain, all postoperative periods showed significant differences when compared to the preoperative period. The sensitivity of the inner region of the arm presented no significant change. CONCLUSION: The difference found in the study shows that evaluations on all scales should be done in several periods, using a proper treatment for the changes and individuality of each patient.

RESUMO O câncer de mama é um dos tipos mais comuns de tumores no mundo e o tipo mais comum entre as mulheres. Existem tratamentos severos para o câncer de mama, no entanto, em muitos casos, podem ser acompanhados por complicações sérias para a vida da mulher. OBJETIVO: Avaliar e comparar a percepção da imagem corporal, a qualidade de vida, a sensibilidade e a dor em mulheres com câncer de mama nos períodos pré-operatório e pós-operatório de 30, 60 e 90 dias. MÉTODOS: Foi realizado um estudo longitudinal prospectivo. Os pacientes responderam ao questionário "Como me relaciono com meu próprio corpo", o EORTC QLQ-C30 e o EORTC QLQ-BR23. Fizemos uma avaliação da sensibilidade do membro superior e da mama com um estesiômetro. Os pacientes foram questionados sobre a presença de dor e seu nível em uma escala de 0 a 10. RESULTADOS: Para a imagem corporal, foi possível observar uma diferença significativa entre o pré e pós-operatório de 30 dias. Mostrou mudanças em algumas áreas dos questionários EORTC QLQ C30 e EORTC QLQ BR23, como sintomas de braço e mama, função social, constipação e função sexual e satisfação, entre outros. Para avaliação da sensibilidade mamária e axilar e avaliação da dor, todos os períodos de pós-operatório apresentaram diferenças significativas quando comparados ao período pré-operatório. A sensibilidade da região interna do braço não apresentou mudanças significativas. CONCLUSÃO: A diferença encontrada no estudo mostra que as avaliações em todas as escalas devem ser feitas em vários períodos, utilizando um tratamento adequado que enfrente as mudanças e a individualidade de cada paciente.

Avaliação linfocintilográfica qualitativa de pacientes com linfedema de membros inferiores tratados com compressão pneumática intermitente por quatro semanas / Qualitative lymphoscintigraphic evaluation of patients with lower limb lymphedema, treated with sequential intermittent pneumatic compression for four weeks

Introdução: O tratamento conservador do linfedema periférico consta de drenagem linfática manual, exercícios terapêuticos, contenção elástica e inelástica e também a compressão pneumática intermitente sequencial. Objetivo: Avaliar o efeito da compressão pneumática intermitente sequencial associada ao uso de contenção inelástica e elástica e exercícios miolinfocinéticos, durante quatro semanas, em pacientes com linfedema das extremidades inferiores, utilizando a análise qualitativa da linfocintilografia e a perimetria. Material e métodos: Dez pacientes portadores de linfedema das extremidades inferiores selecionados por conveniência, totalizando 14 membros acometidos, foram submetidos a quatro semanas de tratamento com compressão pneumática intermitente sequencial, contenção inelástica e elástica e exercícios miolinfocinéticos. Para a avaliação dos membros realizou-se a análise qualitativa da linfocintilografia e também a perimetria dos membros antes e após o tratamento proposto. Resultados: Não foi encontrada diferença estatisticamente significativa nos achados linfocintilográficos pré e pós-tratamento. Contudo, encontrou-se redução significativa da perimetria dos membros (p < 0,01) cuja redução máxima encontrada foi de 5,9% na perimetria do tornozelo e a mínima de 1,8% na perimetria da coxa. Conclusão: O tratamento realizado foi eficaz na redução da perimetria do membro tratado, porém não foi observada alteração significativa nos padrões linfocintilográficos qualitativos para estes pacientes. (AU)

Introduction: Conservative treatment of peripheral lymphedema consists of manual lymphatic drainage, therapeutic exercises, elastic and inelastic compression and sequential intermittent pneumatic compression. Objective: The objective of this study was to evaluate the effect of four weeks of sequential intermittent pneumatic compression combined with elastic and inelastic compression and lymphokinetic exercises on patients with lymphedema of the lower extremities by means of qualitative analysis with lymphoscintigraphy and circumference measurements. Methods: Ten people with lymphedema of the lower limbs, totaling 14 limbs treated, selected by convenience, underwent lymphoscintigraphy before and after four weeks of treatment with sequential intermittent pneumatic compression, elastic and inelastic sleeves and lymphokinetic exercises. For evaluating limbs, were carried out qualitative analysis of lymphoscintigraphy and also circumference measurements before and after the proposed treatment. Results: No statistically significant differences were detected in lymphoscintigraphic findings before and after treatment. However, there was a significant reduction in the circumference measurements (p <0.01) of the limbs. The maximum reduction was found 5.9% in the ankle circumference and the minimum was 1.8% thigh circumference. Conclusion: The treatment was effective at reducing limb circumference, however, no significant changes were observed on the qualitative lymphoscintigraphic analysis for these patients. (AU)

Winged scapula incidence and upper limb morbidity after surgery for breast cancer with axillary dissection.

PURPOSE: The aim of this study was to determine the incidence of winged scapula after breast cancer surgery, its impact on shoulder morbidity and difference in incidence according to surgery type. METHODS: Patients with breast cancer and surgical indication for axillary dissection were included. A total of 112 patients were surveyed with one physical evaluation before the surgery and others 15, 30, 90, and 180 days after. Winged scapula was assessed with test proposed by Hoppenfeld. Shoulder range of motion (ROM) was assessed with goniometer for flexion, extension, adduction, abduction, internal rotation, and external rotation. A verbal scale from 0 to 10 was used to assess pain. RESULTS: Winged scapula incidence was 8.0 % 15 days after surgery. Two patients recovered from winged scapula 90 days after surgery and four more 180 days after surgery, while three patients still had winged scapula at this time. The incidence after 15 days from surgery was 20.9 and 22.6 % among patients submitted to sentinel node biopsy or axillary lymphadenectomy (AL), respectively (p < 0.01). There was no statistical difference of incidence according to breast surgery type. Operated side shoulder flexion, adduction, and abduction ROM changes were statistically different in patients with or without winged scapula. The mean reduction was higher in patients with winged scapula. Both groups showed the same pattern over time in pain. CONCLUSION: Winged scapula incidence was 8.0 % and was higher in AL, and prevalence decreased during 6 months after surgery. Patients who developed winged scapula had more shoulder flexion, adduction, and abduction limitation.

Effectiveness of acupuncture in rehabilitation of physical and functional disorders of women undergoing breast cancer surgery.

PURPOSE: The purpose of the study is to verify the effectiveness of acupuncture in rehabilitation of physical and functional disorders of women undergoing breast cancer surgery on the following parameters: pain, range of motion, upper limb function, and depressive symptoms. METHODS: The following are the inclusion criteria: women aged more than 18 years with scapular girdle and upper limb pain after 3 months of surgery and with pain ≥3 in visual analog scale. Patients were divided into two randomized groups which received weekly treatment during 10 sessions. Kinesiotherapy group (G1)-treated with a predefined kinesiotherapy protocol of 30 min. Group Acupuncture + Kinesiotherapy (G2)-treated with the same kinesiotherapy group protocol followed by another 30 min of acupuncture, used in predefined points. Both groups performed physical examination and answered the upper limb function and depressive symptoms questionnaires. RESULTS: Forty-eight patients completed the treatment, 24 in each group. Regarding the pain, the two groups had statistically significant improvement in all evaluated moments. In the analysis of depression, it improved significantly only in G1 in the comparison between the first and the tenth session. The upper limb function had improvement in G1 only in the comparison between the first and the tenth session and in G2, in the three evaluation moments. The range of motion (ROM) showed improvement in all evaluated movements. CONCLUSIONS: There was no difference between groups. Both groups showed statistically significant improvement of the items assessed: pain, depression, upper limb function, and ADM, and there was no difference between them.

Avaliação da imagem corporal e da função sexual em mulheres com linfedema após tratamento cirúrgico de câncer de mama / Body image and sexual function evaluation in women with lymphedema after surgery of breast neoplasm

O tratamento cirúrgico do câncer de mama pode levar a consequências como diminuição de amplitude de movimento de ombro e cotovelo, dor, fraqueza muscular, alteração de sensibilidade e linfedema. O linfedema, além de prejudicar o desempenho das atividades diárias, pode influenciar a imagem corporal e a função sexual da mulher, afetando, assim, sua qualidade de vida. Objetivou-se avaliar a imagem corporal e a função sexual em mulheres após tratamento cirúrgico de câncer de mama que evoluíram com linfedema. Foram incluídas 40 mulheres do Ambulatório de Mastologia da Universidade Federal de São Paulo e divididas em 2 grupos: grupo controle (n=20), as que não desenvolveram linfedema, e grupo linfedema (n=20). Todas assinaram o Termo de Consentimento Livre e Esclarecido. Foram aplicados, para todas as pacientes, ficha de avaliação, questionários de Imagem corporal "Como me relaciono com o meu corpo" e de Função sexual avaliada pelo Índice de Função Sexual Feminina. Obesidade, sedentarismo e radioterapia foram considerados fatores de risco para o desenvolvimento de linfedema. A imagem corporal não foi influenciada pelo linfedema e se relacionou com a função sexual, apresentando relação diretamente proporcional. O câncer de mama interferiu na formação da imagem corporal e na função sexual das pacientes. Assim, além da alteração anatômica da mama, o câncer promove mudanças biopsicossociais, sendo minimizadas pelo tratamento multidisciplinar.

Breast neoplasm treatment may lead to consequences such as decrease of shoulder and elbow range of motion, pain, muscular weakness, abnormal sensitive and lymphedema. Besides interfering on daily activities, lymphedema can also change body image and female sexual function, affecting women's quality of life. This study aimed to evaluate body image and sexual function on women after surgery treatment of breast neoplasm that developed to lymphedema. Forty women were included in the study. The patients were recruited at Mastology Ambulatory of Universidade Federal de São Paulo. They were separated into 2 groups: control group (n=20), who did not develop lymphedema, and lymphedema group (n=20). All patients signed the Informed Consent. Evaluation form, questionnaires of body image "How do I relate with my body" and of sexual function, assessed by Female Sexual Function Index, were applied to all women involved. Obesity, sedentary lifestyle and radiotherapy were risk factors for lymphedema development. Body image was not influenced by lymphedema, but was related to sexual function, presenting directly proportional relation. Breast neoplasm influenced body image and female sexual function. Thus, in addition to anatomic changes, breast neoplasm promotes biologic, psychology and social changes, requiring a multidisciplinary team to treat women with this disease.

Avaliação da postura e dos movimentos articulares dos membros superiores de pacientes pós-mastectomia e linfadenectomia / Assessment of posture and joint movements of the upper limbs of patients after mastectomy and lymphadenectomy

OBJETIVO: Avaliar as alterações posturais e de amplitudes de movimento de membro superior nas mulheres pós-mastectomia e linfadenectomia que se submeteram à radioterapia como tratamento adjuvante. MÉTODOS: Foram avaliados dois grupos: 16 mulheres pós-mastectomia com linfedema de membro superior e 14 mulheres pós-mastectomia sem linfedema. As pacientes foram submetidas à avaliação feita por programas computadorizados, um para postura e outro para medir as amplitudes de movimento de ombro, cotovelo e punho. Os resultados obtidos foram comparados entre lado direito e esquerdo, e operado e não operado, sendo submetidos a testes estatísticos. RESULTADOS: Ambos os grupos apresentaram anteriorização de tronco. As mulheres com linfedema mostraram rotação de cabeça à direita, protusão de ombro do lado esquerdo e medidas do ângulo de talhe menores do lado operado, além de elevação da escápula bilateralmente, quando comparadas ao grupo sem linfedema. As alterações de amplitude de movimento também foram menores do lado operado na flexão, abdução e rotação externa de ombro para todas as mulheres e, para aquelas que tinham linfedema, a extensão de cotovelo e a flexão de punho tiveram menor amplitude de movimento. CONCLUSÃO: Mulheres que foram submetidas à mastectomia apresentaram assimetrias e alterações de postura, e o linfedema parece agravar essa condição. Além disso, apresentaram déficits de amplitude de movimento em ombros, do lado operado. Mulheres com linfedema exibiram também déficits em cotovelo e punho.

OBJECTIVE: To evaluate alterations in posture and range of motion of the upper limbs in women after mastectomy and lymphadenectomy, submitted to radiotherapy as adjuvant treatment. METHODS: Two groups were evaluated: 16 post-mastectomy women with lymphedema of the upper limb and 14 post-mastectomy women without lymphedema. Patients were submitted to analysis made by software, one for posture and the other to measure ranges of movement of the shoulder, elbow, and wrists. The results obtained were compared between the right and left sides, and operated and non-operated sides, and then were submitted to statistical tests. RESULTS: Both groups presented with anteriorization of the trunk. The women with lymphedema had head rotation to the right, protrusion of the left shoulder, and trunk inclination angle smaller on the operated side, besides bilateral elevation of the scapula when compared to the group with no lymphedema. Changes in range of motion were also smaller on the operated side in terms of flexion, abduction, and external rotation of the shoulder for all women, and for those with lymphedema, elbow extension and wrist flexion had a smaller range of motion. CONCLUSION: Women submitted to mastectomy presented with asymmetries and modifications in posture, and lymphedema seemed to worsen this condition. Additionally, they had deficits in range of motion in the shoulders on the operated side. Women with lymphedema also showed deficits in the elbows and wrist.

Avaliação da qualidade de sono e de força muscular em mulheres com linfedema de membro superior após cirurgia de câncer de mama / Assessment of quality of sleep and muscle strength in women with breast-cancer-related lymphedema

As principais alterações encontradas após cirurgia de câncer de mama são disfunção articular no ombro e linfedema do membro superior homolateral à cirurgia, as quais podem prejudicar a qualidade de vida e a qualidade do sono das mulheres operadas. O objetivo do presente estudo foi verificar se a qualidade de sono e a força muscular estão prejudicadas em pacientes com e sem linfedema após cirurgia de câncer de mama. Estudo transversal analítico realizado com voluntárias após tratamento cirúrgico para câncer de mama, que desenvolveram (grupo linfedema) e que não desenvolveram (grupo controle) linfedema de membro superior, selecionadas no Ambulatório da Disciplina de Mastologia da Universidade Federal de São Paulo. Foi utilizado o questionário de índice de qualidade de sono de Pittsburgh (PSQI), a força muscular foi avaliada através do dinamômetro manual Lafayette® e ao final foi entregue cartilha de higiene do sono. Os dados foram compilados no Excel e o programa estatístico utilizado foi o SigmaStat 3.5®. Houve diferença significante quanto à comparação da perimetria entre os grupos, em seis de oito medidas, caracterizando o grupo linfedema; diminuição da força muscular no lado homolateral à cirurgia, sendo o grupo linfedema o mais alterado. O sono esteve prejudicado nos dois grupos, porém, com queixas diferentes. No grupo linfedema, a principal queixa foi quanto ao posicionamento para dormir e ao enfaixamento compressivo. Observou-se alteração do sono e da força muscular das mulheres que realizaram tratamento cirúrgico para o câncer de mama, sendo pior nas mulheres que desenvolveram o linfedema.

The most common consequences of breast cancer surgery includes joint dysfunction in the ipsilateral shoulder surgery and lymphedema of the upper limb ipsilateral to surgery. Such changes may affect the quality of life and women?s quality of sleep. The purpose of this study was to verify if the quality of sleep and the muscle strength are impaired in patients after surgical treatment for breast cancer, who developed and who didn?t develop lymphedema. An analytical cross study was developed with volunteers after surgical treatment for breast cancer who developed (lymphedema group) and who not developed (control group) lymphedema of the upper limb, in the Clinic of Mastology of the Federal University of São Paulo, Brazil. The questionnaire used was the Pittsburgh Sleep Quality Index (PSQI); muscle strength was assessed by manual dynamometer Lafayette® and in the end it was handed in a booklet of sleep hygiene. The data were put in Excel program and the statistic program used was the SigmaStat 3.5®. There were significant results regarding the perimeter difference between groups in six of eight measures characterizing the group lymphedema; decreased muscle strength was noted in the ipsilateral side to surgery in both groups, being the lymphedema group more affected. Sleep was impaired in both groups, but with different complaints. In the lymphedema group the main complaint was about the position for sleep and compressive bandaging. There was a change in sleeping and muscle strength of women who underwent surgical treatment for breast cancer, being worse in women who developed lymphedema

Avaliação de sensibilidade tátil e função de membro superior no pós-operatório de mastectomia comparado à quadrantectomia / Assessment of tactile sensitivity and function of upper member inthe post surgery of mastectomy compared with quadrantectomy

As cirurgias realizadas para tratamento do câncer de mama podem causar alterações importantes na sensibilidade, função e amplitude de membros superiores, podendo implicar nas atividades de vida diárias. O objetivo do presente estudo foi avaliar a sensibilidade tátil e a função de membro superior em mulheres submetidas à cirurgia por câncer de mama, após 90 dias da operação, comparando os tipos cirúrgicos mastectomia e quadrantectomia. Estudo retrospectivo de corte transversal foi realizado com voluntárias que passaram por tratamento cirúrgico para câncer de mama, no Ambulatório da Disciplina de Mastologia da Universidade Federal de São Paulo. Foram avaliadas a sensibilidade da região do nervo intercostobraquial por meio de estesiômetro de Semmes-Weinstein, a amplitude de movimento pela goniometria e a função de membros superiores por questionário DASH. Não houve diferença estatisticamente significante entre os grupos para a avaliação de sensibilidade, sendo que grande parte das pacientes apresentou grau 0 de incapacidade na sensibilidade das regiões avaliadas (mama, axila e braço); em relação ao DASH, ambos os grupos não tiveram alteração na função, sem diferenças estatisticamente significantes entre os grupos; a amplitude de movimento de flexão de ombro foi menor, com diferença estatisticamente significante no grupo mastectomia. Conclui-se que a sensibilidade e a função de membros superiores foram semelhantes nos grupos mastectomia e quadrantectomia após 90 dias da cirurgia. Quanto à amplitude de movimento, somente o movimento de flexão de ombro foi menor, no grupo mastectomia, com diferença estatisticamente significante.

The surgeries performed to treat breast cancer can cause significant changes in sensitivity, function and range of upper extremities, which may affect the daily living. The objective of this study was to assess tactile sensitivity and upper limb function in women undergoing surgery for breast cancer, after 90 days of operation, comparing the surgical types mastectomy and quadrantectomy. A retrospective cross-sectional study was performed with volunteers who underwent surgical treatment for breast cancer at the Division of Mastology Ambulatory in the Federal University of São Paulo, Brazil. The sensitivity of the intercostal nerve region was assessed using the Semmes- Weinstein esthesiometer, the range of motion was assessed by goniometry and the function of upper limbs was assessed by a DASH questionnaire. There was no statistically significant difference between groups for the evaluation of sensitivity, most patients had grade 0 disability sensitivity of regions evaluated (breast, armpit and arm); regarding DASH, both groups had no change function and no significant difference between groups; shoulder flexion was lower, with a statistically significant difference, in the mastectomy group. We concluded that the sensitivity and function of the upper limbs were similar in the groups quadrantectomy and mastectomy 90 days after surgery. As for range of motion, only the movement of flexion was lower with a statistically significant difference in the mastectomy group.

Assessment of posture and joint movements of the upper limbs of patients after mastectomy and lymphadenectomy.

OBJECTIVE: To evaluate alterations in posture and range of motion of the upper limbs in women after mastectomy and lymphadenectomy, submitted to radiotherapy as adjuvant treatment. METHODS: Two groups were evaluated: 16 post-mastectomy women with lymphedema of the upper limb and 14 post-mastectomy women without lymphedema. Patients were submitted to analysis made by software, one for posture and the other to measure ranges of movement of the shoulder, elbow, and wrists. The results obtained were compared between the right and left sides, and operated and non-operated sides, and then were submitted to statistical tests. RESULTS: Both groups presented with anteriorization of the trunk. The women with lymphedema had head rotation to the right, protrusion of the left shoulder, and trunk inclination angle smaller on the operated side, besides bilateral elevation of the scapula when compared to the group with no lymphedema. Changes in range of motion were also smaller on the operated side in terms of flexion, abduction, and external rotation of the shoulder for all women, and for those with lymphedema, elbow extension and wrist flexion had a smaller range of motion. CONCLUSION: Women submitted to mastectomy presented with asymmetries and modifications in posture, and lymphedema seemed to worsen this condition. Additionally, they had deficits in range of motion in the shoulders on the operated side. Women with lymphedema also showed deficits in the elbows and wrist.