Cinira Assad Simão Haddad

Avaliação da postura e dos movimentos articulares dos membros superiores de pacientes pós-mastectomia e linfadenectomia

ABSTRACT Objective: To evaluate alterations in posture and range of motion of the upper limbs in women after mastectomy and lymphadenectomy, submitted to radiotherapy as adjuvant treatment. Methods: Two groups were evaluated: 16 post-mastectomy women with lymphedema of the upper limb and 14 post-mastectomy women without lymphedema. Patients were submitted to analysis made by software, one for posture and the other to measure ranges of movement of the shoulder, elbow, and wrists. The results obtained were compared between the right and left sides, and operated and non-operated sides, and then were submitted to statistical tests. Results: Both groups presented with anteriorization of the trunk. The women with lymphedema had head rotation to the right, protrusion of the left shoulder, and trunk inclination angle smaller on the operated side, besides bilateral elevation of the scapula when compared to the group with no lymphedema. Changes in range of motion were also smaller on the operated side in terms of flexion, abduction, and external rotation of the shoulder for all women, and for those with lymphedema, elbow extension and wrist flexion had a smaller range of motion. Conclusion: Women submitted to mastectomy presented with asymmetries and modifications in posture, and lymphedema seemed to worsen this condition. Additionally, they had deficits in range of motion in the shoulders on the operated side. Women with lymphedema also showed deficits in the elbows and wrist.

Diagnosis of Axillary Web Syndrome in Patients After Breast Cancer Surgery: Epidemiology, Risk Factors, and Clinical Aspects

Objectives: Axillary web syndrome (AWS) is a complication after breast cancer surgery associated with the axillary approach. We defined a diagnosis tool as well as evaluated cord frequency, characteristics, and risk factors. Methods: A prospective cohort study of 173 women followed-up at Breast Diseases Division of Universidade Federal de São Paulo between July 2014 and September 2015 was established as an evaluation protocol to diagnose AWS. Sociodemographic status, anthropometric values, range of motion, comorbidities, pain, cord frequency, and characteristics (localization, number, palpable, and/or visible) among other data were collected at different time points before and after surgery. Results: The majority of the cords appeared by the seventh day (66.1%), and the total incidence of the cords was 90.9% at the 180th day. The axilla was the place for 80% of the occurrence of AWS, and >70% of the cords were palpable. Flexion and abduction of the shoulder showed reduced range of motion. Pain was present in 39.7% of the patients. Lymphadenectomy as well as hypertension were associated with increased risk of cord development; diabetes was associated with a decreased risk. Conclusions: The evaluation protocol applied here showed a high incidence of AWS, with palpable cords more frequent than visible ones. The significance of hypertension and diabetes mellitus as risk factors for cord development in AWS should be evaluated in future studies. The evaluation protocol developed in this study seems to be of great importance for early detection of AWS and could also be valuable for future treatment planning.

Complex Therapy Physical alone or Associated with Strengthening Exercises in Patients with Lymphedema after Breast Cancer Treatment: a Controlled Clinical Trial

Objective: To compare a complex physical therapy (CPT) protocol alone or combined with complex physical therapy muscle more strength training (CPT+ST) in patients with lymphedema after breast cancer treatment regarding strength and limb muscle volume. Methods: In this controlled clinical trial, consecutive patients treated from breast cancer from April 2014 to December 2015 were allocated in two groups, the CPT group 1 and the CPT+ST group 2, that performed CPT associated with muscle strengthening. Patients in the CPT group 1 received the routine protocol of care, consisting of manual lymphatic drainage (MLD), multilayer bandage compression therapy, skin care and regular exercises. Patients CPT+ST performed, 2 sets of 10 repetitions exercises at 40% of maximal voluntary contraction the first week, increasing to 3 sets with 10 repetitions during the second and third weeks, 3 sets with 15 repetitions, for 8 weeks, 50 minutes per session, twice per week. Strength and muscle volume were analyzed. Result: In the study period, 42 patients were enrolled, 22 in the CPT group 1 and 20 in the CPT+ST group 2. Only 36 completed treatment. Both groups showed similar increases in the range of movement in: shoulder flexion, extension, adduction, abduction and external rotation. Internal rotation showed less improvement in CPT+ST group 2 (p = 0,034). Strength improvement was similar between groups. The CPT+ST group 2 seemed to have a greater volume in the upper limb when compared to CPT group 1, but it was not possible to prove any significant difference (p = 0.555). Conclusion: There was no difference of muscular limb volume between the two interventions. This means that strengthening exercises can be performed by patients with lymphedema safely, without the risk of increasing upper limb volume with edema.

Abstract P2-12-03: Prospective study of acupuncture in the rehabilitation of women undergoing surgical treatment of breast cancer in relation to the strength and quality of life

Objective : To investigate the benefits of acupuncture in relation to the shoulder muscle strength and quality of life in women undergoing surgical treatment for breast cancer. Methods : Women with breast cancer, aged 18 years or more, with pain level ≥ 3 in the Visual Analog Scale in shoulder girdle or upper limb three months after surgery, were included in this prospective study. The patients were randomly divided into two groups and received weekly treatment for 10 sessions. Kinesiotherapy group (G1): treated with pre-defined standard kinesiotherapy, lasting 30 minutes. Group Acupuncture + Kinesiotherapy (G2): treated with the same Kinesiotherapy group protocol followed by another 30 minutes of acupuncture using pre-defined points. Acupuncture points used were as follows: CV 3, SP 9, ST 36, KD 7, LV 3, GB 21, LI 15, SJ 14, LU 5, LI 4, ST 38 and BL 60. Patients were evaluated at baseline, after five weeks and at the end of 10 weeks. Parameters studied were: clinical profile and socio-demographic data, muscle strength and quality of life. Results: 48 patients completed treatment, 24 in each group. Regarding shoulder muscle strength, all movements showed improvement and there was no statistical difference between groups. However, when analyzing intragroup changes, improvement of flexion and internal rotation were observed in G1 and increase of all movements were found in G2. Concerning EORTC, there was statistically significant difference between groups of pain symptom in the 5th session, with better score in patients of G2 in relation to G1. About EORTC intragroups results, G1 showed improvement in physical function, pain and insomnia; and G2 in performance roles, fatigue and pain. Conclusion : According to this prospective study, kinesiotherapy and acupuncture had a positive effect on the shoulder muscle strength and quality of life of patients. Keywords: 1. Breast cancer. 2. Rehabilitation. 3. Acupuncture. 4. Muscle Strength. 5. Quality of life. Citation Format: Giron PS, Haddad CA, Rizzi SL, Pinheiro TL, Luz RP, Nazario AP, Facina G. Prospective study of acupuncture in the rehabilitation of women undergoing surgical treatment of breast cancer in relation to the strength and quality of life [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-12-03.

Tratamento da dor pós-mastectomia pela acupuntura com pastilhas de óxido de silício: relato de caso

Post-mastectomy painful syndrome is commonly diagnosed in association with shoulder osteoarthritis, resulting in further limitation of arm movement due to pain. It is not unusual for the various drug-based and/or physiotherapeutic pain managements to show poor results. The alternative or complimentary medicine aims at improving conditions for which the orthodox medical treatment has a low rate of success or is not affordable. The present case report is about an improved application of acupuncture treatment where arrays of minute silicon dioxide crystals commercially known as Stiper pads were applied to treat women showing restriction of movement in the shoulder joint after breast cancer treatment. Sindrome dolorosa pos-mastectomia e geralmente diagnosticada em associacao com osteoartrite na articulacao do ombro, resultando em limitacao agravada de movimento do braco devido a dor. Nao e incomum que varios tratamentos paliativos baseados no uso de drogas e/ou procedimentos fisioterapeuticos para dor tenham um baixo indice de sucesso, ou ainda, tenham um custo nao dentro das possibilidades financeiras do paciente. O presente relato de caso diz respeito a uma aplicacao melhorada de tratamento por acupuntura no qual uma serie de minusculos cristais de dioxido de silicio, conhecidos pela denominacao adesivos Stiper®, foram aplicados para tratar mulheres que tinham restricao de movimento da articulacao do ombro depois de tratamento de câncer de mama.