The Relationship between the Upper Extremity Volume and Disability,Thoracic Kyphosis, Shoulder Protraction, and Forward Head Posture in Patients with Upper Extremity Lymphedema Following Total Mastectomy

Abstract

Background: Upper extremity (UE) lymphedema, which negatively affects patients’ personal and social well-being, is the most common complication after breast cancer treatment. Previous studies have demonstrated the adverse effectsof surgical interventions for breast cancer on spinal postures and UE disability;however, no studies have examined the relationships between UE volume and postural changes and between UE volume and UE disability in patients withlymphedema. Furthermore, some spinal postural changes in patients with forward head posture (FHP) remain unassessed in these patients. Therefore, the present study investigated the relationship between the volume of the affected UE with FHP, kyphosis, shoulder protraction, and UE disability in lymphedema patients.Methods: The present cross-sectional study was carried out on 32 women with unilateral UE lymphedema. UE volume and kyphosis were measured by volumetry and a flexible ruler, respectively. Cervical angle was used to assess FHP. To measure shoulder protraction and FHP, data obtained from markers and photography was analyzed in ImageJ software. The disability of the affected UE was assessed by the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Data analysis was performed using Pearson’s correlation test.Results: Significant positive correlations were observed between UE volume and UE disability as well as kyphosis. Significant negative correlations between UE volume and shoulder as well as cervical angle were also seen. UE disabilityhad a significant negative correlation with shoulder angle but no significant relationship with kyphosis or cervical angle.Conclusion: An increase in the affected UE volume due to lymphedema is related to an increase in UE disability, kyphosis angle, FHP, and shoulder protraction. In addition to treatments for UE volume reduction in lymphedema patients,accurate posture evaluation is also recommended.

Keywords

• breast cancer lymphedema
• kyphosis
• posture
• shoulder
• spine
• disability evaluation