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. 2014 Jan-Mar;27(1):4-11.
doi: 10.1016/j.jht.2013.08.021. Epub 2013 Sep 29.

Mechanosensitivity in the upper extremity following breast cancer treatment

Betty Smoot  1 , Benjamin S Boyd  2 , Nancy Byl  3 , Marylin Dodd  4
Affiliations

Mechanosensitivity in the upper extremity following breast cancer treatment

Betty Smoot et al. J Hand Ther. 2014 Jan-Mar.

Abstract

Study design: Descriptive, cross-sectional.

Introduction: Breast cancer (BC) treatments place the nervous system at risk, which may contribute to upper extremity (UE) mechanosensitivity.

Purpose of the study: To evaluate elbow extension range of motion (EE-ROM) during upper limb neurodynamic testing (ULNT) post-BC treatment.

Methods: ULNT EE-ROM was measured for 145 women post-BC treatment. Women were sub-grouped by presence/absence of pain and lymphedema.

Results: Mean EE-ROM during ULNT1 was -22.3° (SD 11.9°) on the unaffected limb and -25.99° (SD 13.1°) on the affected limb. The women with pain and lymphedema had the greatest limitation in EE-ROM during ULNT1 testing, particularly of their affected limb (-33.8°, SD 12.9). Symptoms were reported more frequently in the affected chest, shoulder, arm, elbow, and hand. The intensity of symptoms was greater at the affected chest (p = 0.046), shoulder (p = 0.033) and arm (p = 0.039).

Conclusions: Women with lymphedema and pain after BC treatment may present with altered neural mechanosensitivity.

Level of evidence: 3a.

Keywords: Breast cancer; Lymphedema; Neurodynamics.

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Figures

Figure 1
Figure 1. Range of motion during ULNT
Elbow extension range of motion in degrees during upper limb neurodynamic testing (ULNT). Full elbow extension to neutral is defined as 0°. Negative numbers represent a limitation in attaining full extension (flexed position). The affected limb and unaffected limb are presented for women with breast cancer (BC) and were subdivided into those with the following complications: 1) pain in affected limb with presence of lymphedema (+Pain/+LE), 2) pain in the affected limb without lymphedema (+Pain/−LE), 3) no pain in the affected limb with presence of edema (−Pain/+LE), and 4) no pain in the affected limb without lymphedema (−Pain/−LE). Group mean values are presented with standard deviation error bars. The following identify statistical differences; asterisks (*) indicate significant within group differences between limbs, cross (†) indicates significant between group differences for the affected limb, double cross (††) indicates significant between group differences for the unaffected limb.
Figure 2
Figure 2. Symptomatic response in women with breast cancer during ULNT1
The percent of women reporting symptoms in the final test position for the ULNT1 are presented (bolded) for each of the following regions: chest, shoulder, arm, elbow, forearm, wrist, hand, and each of the digits. The intensity of symptoms reported on a 0 to 10 point numeric rating scale are reported in mean (SD). Significant between limb differences are notated with an asterisk (*) based upon the related samples Wilcoxon Signed Rank test.
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