Mohamed Mahmoud Hamada, Radwan Rafik E, ElMeligie Mohamed M, Ahmed Abdelrazak, Sakr Hend R, ElShazly Mahmoud
Department of Physical Therapy for Surgery, Faculty of Physical Therapy Ahram Canadian University, 4 Industrial Zone, Banks Complex, 6th of October City, Giza, Egypt.
Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
Support Care Cancer. 2024 Dec 17;33(1):37. doi: 10.1007/s00520-024-09044-7.
This study aimed to investigate the impacts of breast cancer-related lymphedema (BCRL) severity on shoulder function including range of motion, strength, muscle activation patterns, and patient-reported disability.
A cross-sectional, observational study design was utilized. Seventy-five women with unilateral BCRL were recruited and categorized into mild, moderate, and severe groups based on limb swelling severity. Outcomes included shoulder range of motion, isometric strength, Disabilities of Arm Shoulder and Hand (DASH) scores for disability, and surface electromyography (EMG) of shoulder muscles. Data were analyzed using parametric and nonparametric tests.
Increasing lymphedema severity was associated with progressive declines in shoulder mobility, strength, and function. Severe cases showed markedly reduced shoulder flexion, abduction, rotation, and extension range of motion along with decreased isometric flexor and abductor strength versus mild cases (p < 0.001). Higher pain levels (p < 0.001) and DASH disability scores (p < 0.001) were noted in severe BCRL. Surface EMG revealed impaired activation patterns including reduced amplitudes (p < 0.001) and delayed onsets (p < 0.001) in the deltoids, rotator cuff, and scapular muscles with greater impairment.
Advancing BCRL severity was associated with substantial declines in shoulder mobility, strength, neuromuscular activation, pain threshold, and upper limb functionality. These quantitative results demonstrate impaired shoulder joint control underlying disability in arm elevation and daily tasks. The progressive nature of these deficits highlights the relationship between lymphedema severity and shoulder dysfunction in breast cancer survivors.
本研究旨在调查乳腺癌相关淋巴水肿（BCRL）严重程度对肩部功能的影响，包括活动范围、力量、肌肉激活模式以及患者报告的残疾情况。
采用横断面观察性研究设计。招募了75名单侧BCRL女性，并根据肢体肿胀严重程度分为轻度、中度和重度组。结果包括肩部活动范围、等长力量、手臂肩部和手部残疾（DASH）评分以及肩部肌肉的表面肌电图（EMG）。使用参数检验和非参数检验对数据进行分析。
淋巴水肿严重程度增加与肩部活动度、力量和功能的逐渐下降相关。与轻度病例相比，严重病例的肩部前屈、外展、旋转和伸展活动范围明显减小，等长屈肌和外展肌力量降低（p < 0.001）。严重BCRL患者的疼痛水平（p < 0.001）和DASH残疾评分更高（p < 0.001）。表面肌电图显示激活模式受损，包括三角肌、肩袖肌和肩胛肌的振幅降低（p < 0.001）和起始延迟（p < 0.001），且损伤更严重。
BCRL严重程度的增加与肩部活动度、力量、神经肌肉激活、疼痛阈值和上肢功能的显著下降相关。这些定量结果表明，在手臂抬高和日常任务中，残疾背后存在肩关节控制受损。这些缺陷的渐进性突出了乳腺癌幸存者中淋巴水肿严重程度与肩部功能障碍之间的关系。
