Recent study: when to start shoulder exercise following axillary dissection

Hello all, I just wanted to post some info I read in an article in the most recent physiotherapy journal - A randomised controlled trial of two programmes of shoulder exercise following axillary node dissection for invasive breast cancer.

I am a physiotherapist but have no experience with breast cancer patients but was diagnosed with breast cancer in July and have just had a mastectomy and axillary clearance.

This trial based in Leeds from 2003-2006 compared early mobilisation - Moving the arm above the shoulder within 48hrs, with delayed mobilisation - i.e. restricted movement to below the shoulder for the first 7 days.
There were 116 women who took part (6% did not complete the study), mean age 57years
Outcomes evaluated were: developing lymphoedema, range of shoulder movement, grip strength & quality of life quesionaires

Results: No statistical difference between groups in shoulder movement, grip strength or quality of life questionnaires at 1yr post op.
Incidence of lymphoedema was 22%, and statistically different between groups, early mobilisation 16 patients developed lymphodema compared to 6 in the delayed mobilisation group.

Strengths/weaknesses: Low recruitment of the study - 64% declined to take part. 70% of women who develop lymphoedema do so in the first 1yr, hence the 1yr follow up. This study supports other studies who recommend delayed mobilisation, despite only 59% of breast care units recommending delayed mobilisation.

They conclude: After axillary node dissection post-op exericse should restrict arm movements to below shoulder level for the 1st 7 days.

I hope this is of interest, I have summarised the findings so please read the full article and its references, it can be found in Physiotherapy Vol. 94 (2008) pg265-273 - A randomised controlled trial of two programmes of shoulder exercise following axillary node dissection for invasive breast cancer.

Hi Charliechoo

That’s very interesting - is the full article available online? (You might be allowed to add a link uf it is). The information about lymphoedema particularly intrigued me…

The statistic above that about 70% of women who develop lymphoedema do so in the first year surprised me. According to the literature I have, the peak time is around 3 and a half years after treatment. Does the article also say how many of the 116 were also given radiotherapy and which groups they were in?

A mean age is quoted here, is there a median available as well? Lymphatic systems, as you’ll know, function less well as we get older.

Thanks for a thought-provoking post.

S

I think early exercise after surgery led to increasing seroma and contributed to my wound infection. I can’t see the point of making yourself feel worse by exercising when you are in pain so this makes complete sense to me

Mole

One of the plastic surgeons told me not to lift/raise my arm above certain level/above shoulder, take it easy, move only lower arm part, no exercise or physio for six weeks. he said it takes 6 weeks for the tissue to bond and heal. I followed his advice. I have no lymphodema and my healing is speedy. I started exercising my arm after 6 - 7 weeks. I do have cording but it is easing as time goes by. Now only slight tightness, but after massage and exercises, the cording softened.

Hi Bahons2,
The article I don’t think is online but you can request the article from your library or private message me your address and i’ll send you a photo copy.
I thought the 70% statistic was pretty high, it referenced from another study ‘lymphoedema following surgery for breast cancer’ in the british Journal of Surgery 2000;87:1128-41.
The characteristics of each group is stated in the article and seem to be fairly similar. For example radiotherapy was used post surgery with 67% of the delayed mobilisation group and 71% of the early mobilisation group. Adjuvant chemotherapy in 52% of the delayed mobilisation group and 45% of the early mobilisation group.
The age is similar too, delayed mobilisation age range was 35-87 and early mobilisation range was 27-83.