Top

Published in:

01-06-2016 | Original Article

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

Authors: Samantha Karlla Lopes de Almeida Rizzi, Cinira Assad Simão Haddad, Patricia Santolia Giron, Thaís Lúcia Pinheiro, Afonso Celso Pinto Nazário, Gil Facina

Published in: Supportive Care in Cancer | Issue 6/2016

Abstract

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.

McNeely ML, Campbell K, Ospina M, Rowe BH, Dabbs K, Klassen TP, et al. Exercise interventions for upper-limb dysfunction due to breast cancer treatment. In: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2010 [cited 2015 Nov 9]. Available from: http://doi.wiley.com/10.1002/14651858.CD005211.pub2

Mastrella AS, Freitas-Junior R, Paulinelli RS, Soares LR (2009) Winged scapula after axillary clearance in the treatment of breast cancer. Rev Bras Cancerol 55(4):397–404

Pereira TB, Bergmann A, Ribeiro ACP, Da Silva JG, Dias R, Ribeiro MJP et al (2009) Myoeletric activity pattern of scapular muscles after axillary lymphadenectomy in breast cancer. Rev Bras Ginecol Obstet 31(5):224–229CrossRefPubMed

Kapandji IA (1990) Fisiologia articular: esquemas comentados de mecânica humana. Barueri. Manole. V3

Dângelo JG, Fattini CA (1998) Anatomia Humana Sistêmica e Segmentar para o estudante de medicina. 2ª edição. Editora Atheneu, Rio de Janeiro, p 671

Martin RM, Fish DE (2008) Scapular winging: anatomical review, diagnosis, and treatments. Curr Rev Musculoskelet Med 1(1):1–11CrossRefPubMedPubMedCentral

Cerqueira WA, Barbosa LA, Bergmann A (2009) Physiotherapy proposal for the emergency service in patients with winged scapula associated to axillary lymphadenectomy. Rev Bras Cancerol 55(2):155–120

Schultz JS (2004) Clinical evaluation of the shoulder. Phys Med Rehabil Clin N Am 15(2):351–371CrossRefPubMed

Petito EL, Gutiérrez MGR (2008) Development and validation of an exercise program for women submitted to breast cancer surgery. Rev Bras Cancerol 54(3):275–287

10.

Hoppenfeld S (2002) Exame do ombro. In: Hoppenfeld S (ed) Propedêutica ortopédica coluna e extremidades. Atheneu, Rio de Janeiro

11.

Silva JA, Ribeiro-Filho NP (2006) Avaliação e mensuração da dor: pesquisa, teoria e prática. FUNPEC Editora, Ribeirão Preto, SP

12.

Adriaenssens N, De Ridder M, Lievens P, Van Parijs H, Vanhoeij M, Miedema G et al (2012) Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image-guided radiotherapy. World J Surg Oncol 10:86CrossRefPubMedPubMedCentral

13.

Verbelen H, Gebruers N, Eeckhout F-M, Verlinden K, Tjalma W (2014) Shoulder and arm morbidity in sentinel node-negative breast cancer patients: a systematic review. Breast Cancer Res Treat 144(1):21–31, Available from: http://link.springer.com/10.1007/s10549-014-2846-5 CrossRefPubMed

14.

Langer I, Guller U, Berclaz G, Koechli OR, Schaer G, Fehr MK et al (2007) Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg 245(3):452–461CrossRefPubMedPubMedCentral

15.

Mastrella A de S, Freitas-Junior R, Paulinelli RR, Soares LR (2014) Incidence and risk factors for winged scapula after surgical treatment for breast cancer. J Clin Nurs 23(17-18):2525–2531CrossRef

16.

Nevola Teixeira LF, Lohsiriwat V, Schorr MC, Luini A, Galimberti V, Rietjens M et al (2014) Incidence, predictive factors, and prognosis for winged scapula in breast cancer patients after axillary dissection. Support Care Cancer 22(6):1611–1617CrossRefPubMed

17.

Oliveira JF, Bezerra T, Ribeiro ACP, Dias RA, Abrahão F, Silva JG, Bergmann A (2009) Incidence and risk factors of winged scapula after axillary lymph node dissection in breast cancer surgery. Appl Can Res 29:69–73

18.

Lee S, Savin DD, Shah NR, Bronsnick D, Goldberg B (2015) Scapular winging: evaluation and treatment: AAOS exhibit selection. J Bone Joint Surg Am 97(20):1708–1716CrossRefPubMed

19.

Rizzi SKLA, Simão CAH, Nazário ACP, Facina G (2013) Scapula dysfunction after breast cancer surgery: systematic review. FEMINA 41(4):221–228

20.

Belmonte R, Monleon S, Bofill N, Alvarado ML, Espadaler J, Royo I (2015) Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection. Support Care Cancer 23(1):169–175CrossRefPubMed

21.

Shamley D, Lascurain-Aguirrebeña I, Oskrochi R, Srinaganathan R (2012) Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy. Acta Oncol 51(8):1045–1053CrossRefPubMed

22.

Weon J-H, Kwon O-Y, Cynn H-S, Lee W-H, Kim T-H, Yi C-H (2011) Real-time visual feedback can be used to activate scapular upward rotators in people with scapular winging: an experimental study. J Physiother 57(2):101–107CrossRefPubMed

23.

Roren A, Fayad F, Poiraudeau S, Fermanian J, Revel M, Dumitrache A et al (2013) Specific scapular kinematic patterns to differentiate two forms of dynamic scapular winging. Clin Biomech (Bristol, Avon) 28(8):941–947CrossRef

24.

Warner JJ, Navarro RA (1998) Serratus anterior dysfunction: recognition and treatment. Clin Orthop Relat Res 349:139–148CrossRefPubMed

25.

Gregg JR, Labosky D, Harty M, Lotke P, Ecker M, DiStefano V et al (1979) Serratus anterior paralysis in the young athlete. J Bone Joint Surg Am 61(6A):825–832PubMed

Title: Winged scapula incidence and upper limb morbidity after surgery for breast cancer with axillary dissection
Authors: Samantha Karlla Lopes de Almeida Rizzi
Cinira Assad Simão Haddad
Patricia Santolia Giron
Thaís Lúcia Pinheiro
Afonso Celso Pinto Nazário
Gil Facina
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 6/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-016-3086-5

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2016

Use of olanzapine for the relief of nausea and vomiting in patients with advanced cancer: a multicenter survey in Japan

Satisfaction with cancer care among American Indian and Alaska Natives in Oregon and Washington State: a qualitative study of survivor and caregiver perspectives

Long-term safety of fentanyl sublingual spray in opioid-tolerant patients with breakthrough cancer pain

Predicting early post-chemotherapy adverse events in patients with hematological malignancies: a retrospective study

Predictors of quality of life in head and neck cancer survivors up to 5 years after end of treatment: a cross-sectional survey

Psychometric properties of the Arabic version of EORTC QLQ-C15-PAL among cancer patients in Jordan

Keynote webinar | Spotlight on antibody–drug conjugates in cancer