Tan Cynthia, Wilson Christopher M
Physical Therapy, Beaumont Health, Royal Oak, USA.
Physical Therapy, Oakland University, Rochester, USA.
Cureus. 2019 May 30;11(5):e4779. doi: 10.7759/cureus.4779.
Breast cancer is the most commonly diagnosed cancer in women and approximately 33% of survivors will develop lymphedema. Untreated lymphedema may be limb threatening or cause substantial functional limitations. The purpose of this case report is to detail the physical therapy (PT) management and outcomes for a patient with right upper extremity and breast lymphedema. The goal of this case report is to provide rehabilitation clinicians with an example of effective treatment management and the underlying treatment rationale. A 64-year-old female with stage 2A breast cancer underwent neoadjuvant chemotherapy, a lumpectomy with 18 lymph nodes removed, and radiation therapy. She subsequently developed secondary lymphedema of the right breast and upper extremity. Physical therapy interventions included instruction on a complete decongestive therapy program, which consists of manual lymphatic drainage and compression bandaging and exercises to improve shoulder range of motion (ROM), posture, and strength. As a result of PT, her right shoulder ROM and anthropometric measurements improved and the patient achieved independence with self-lymphatic massage and compression bandaging techniques to maintain these gains. This case report is unique as it details the clinical decision making required during a complex course of cancer care that necessitated adjustments to the PT plan of care for sustainable outcomes.
乳腺癌是女性中最常被诊断出的癌症，约33%的幸存者会发展为淋巴水肿。未经治疗的淋巴水肿可能会威胁肢体或导致严重的功能受限。本病例报告的目的是详细介绍一名患有右上肢体和乳腺淋巴水肿患者的物理治疗（PT）管理及结果。本病例报告的目标是为康复临床医生提供一个有效治疗管理及潜在治疗原理的示例。一名64岁的2A期乳腺癌女性接受了新辅助化疗、切除18个淋巴结的肿块切除术以及放射治疗。随后，她出现了右乳和右上肢体的继发性淋巴水肿。物理治疗干预包括指导一套完整的消肿治疗方案，该方案包括手动淋巴引流、加压包扎以及改善肩部活动范围（ROM）、姿势和力量的锻炼。经过物理治疗，她的右肩活动范围和人体测量指标得到改善，患者在自我淋巴按摩和加压包扎技术方面实现了独立，以维持这些改善。本病例报告具有独特性，因为它详细介绍了在复杂的癌症治疗过程中所需的临床决策，这需要对物理治疗护理计划进行调整以实现可持续的结果。
