Evaluation of Long-Term Effect of Clinical Physiotherapy Treatment Protocol for Post Cancer Mastectomy Induced Lymphadenopathy and Restricted Joint Range: A Novel Protocol Case Study

Abstract

Mastectomy is a treatment for breast cancer over breast-conserving surgeries. There are many side effects known post-mastectomy. Some of which are pain tenderness, swelling at the surgery site, lymphadenopathy, buildup of blood in the wound (hematoma), the buildup of clear fluid in the wound (seroma), limited arm or shoulder movement, numbness in the chest or upper arm, neuropathic pain [1]. Mastectomy also caused the psychological impact on half of the patients, which included fear of cancer, feeling of body incompleteness, inconvenience in working and social communication, less sexual act and low spirit [2]. Lymphedema in women treated for breast cancer is an accumulation of protein-rich fluid in the arm that occurs when axillary lymphatic drainage from the arm is interrupted because of axillary lymph node dissection or axillary radiation or both [3]. Lymphedema is still of great concern as no modern modalities have shown significant results in reducing lymphedema. This leads to dysfunction in the shoulder joint and restriction in joint range. Three stages of lymphedema have been described in studies that are: Stage I presents with pitting and is considered reversible; some women with this stage have no increased arm girth or heaviness and no signs of pitting edema. As the edema progresses, it becomes brawny, fibrotic, nonpitting and irreversible in stage II. In advanced lymphedema i.e. in stage III, which rarely occurs following breast cancer treatments, cartilaginous hardening occurs, with papillomatous outgrowths and hyperkeratosis of the skin [4-6]. Chronic lymphedema gives rise to a chronic inflammatory state and consequent fibrosis that make the joint range more difficult to treat with pain [7]. This further leads to symptoms such as pain, disfigurement, and disability.