Mastektomi Sonrası Gelişen Lenfödem Şiddetinin Skapular Kinematiklere Etkisinin İncelenmesi

Abstract

The aim of this study was to examine the effect of lymphedema severity on scapular kinematics in post-mastectomy patients with moderate to severe lymphedema and non-lymphedema which were divided according to the volumetric difference. 46 women who underwent radical or modified radical mastectomy as part of their breast cancer treatment were included. Patients were divided into 3 groups as no lymphedema (n=15), moderate lymphedema (n=15) and severe lymphedema (n=16). Volumetric measurements by measuring the upper extremity volumes, the active range of motion with the inclinometer, The Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Quick DASH) and scapula kinematic analysis with the electromagnetic system at 30-60-90 ° lifting and lowering of the arm elevation were recorded. The obtained data were analyzed by nonparametric tests. The duration of lymphedema was higher in the severe lymphedema group than in the moderate lymphedema group (p<0.05). In the measurement of joint range of motion, it was seen that the affected joint was lower than the unaffected joint range of motion in all groups (p <0.05). There was a significant difference between the three groups in terms of DASH score (p <0.05). As the severity of lymphedema increased, the DASH score increased. No significant difference was found between the affected arms in terms of scapular kinematics (p >0.05). In the correlation test between the duration of lymphedema and the scapular kinematics, as the lymphedema duration increased, a middle-strength correlation was detected in the direction of scapular kinematics deterioration (p<0.05). In conclusion, it was concluded that the cause of scapular kinematics was largely lymphedema duration than the severity of lymphedema. As a result of the study, the cases were compared between the groups, intra-group differences and literature, and various deviations were observed in the normal scapular movement patterns of both affected and unaffected scapula. For this reason, we believe that when this patient group is being treated, not only the affected side but also the unaffected side should be included in the treatment program. In further studies, there is a need for studies to include larger sample groups in this group of patients and to compare patients with healthy control groups so that deviations from the scapula can be better understood.