Winged scapula incidence and upper limb morbidity after surgery for breast cancer with axillary dissection

• Published in: Supportive care in cancer Vol. 24; no. 6; pp. 2707 - 2715
• Main Authors: Rizzi, Samantha Karlla Lopes de Almeida, Haddad, Cinira Assad Simão, Giron, Patricia Santolia, Pinheiro, Thaís Lúcia, Nazário, Afonso Celso Pinto, Facina, Gil
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2016; Springer; Springer Nature B.V
• Subjects: Axilla - surgery; Breast cancer; Breast Neoplasms - surgery; Cancer surgery; Cohort Studies; Female; Hostages; Humans; Incidence; Kidnapping; Lymph Node Excision - adverse effects; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Peripheral Nerve Injuries - epidemiology; Peripheral Nerve Injuries - etiology; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Range of Motion, Articular - physiology; Rehabilitation Medicine; Scapula - innervation; Scapula - physiopathology; Shoulder; Shoulder - innervation; Shoulder - physiopathology; Surgical outcomes; Surgical Procedures, Operative - adverse effects; Peripheral nerve injuries; Breast neoplasms; Scapula; Shoulder; Morbidity
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-016-3086-5

Purpose The aim of this study was to determine the incidence of winged scapula after breast cancer surgery, its impact on shoulder morbidity and difference in incidence according to surgery type. Methods Patients with breast cancer and surgical indication for axillary dissection were included. A total of 112 patients were surveyed with one physical evaluation before the surgery and others 15, 30, 90, and 180 days after. Winged scapula was assessed with test proposed by Hoppenfeld. Shoulder range of motion (ROM) was assessed with goniometer for flexion, extension, adduction, abduction, internal rotation, and external rotation. A verbal scale from 0 to 10 was used to assess pain. Results Winged scapula incidence was 8.0 % 15 days after surgery. Two patients recovered from winged scapula 90 days after surgery and four more 180 days after surgery, while three patients still had winged scapula at this time. The incidence after 15 days from surgery was 20.9 and 22.6 % among patients submitted to sentinel node biopsy or axillary lymphadenectomy (AL), respectively ( p  < 0.01). There was no statistical difference of incidence according to breast surgery type. Operated side shoulder flexion, adduction, and abduction ROM changes were statistically different in patients with or without winged scapula. The mean reduction was higher in patients with winged scapula. Both groups showed the same pattern over time in pain. Conclusion Winged scapula incidence was 8.0 % and was higher in AL, and prevalence decreased during 6 months after surgery. Patients who developed winged scapula had more shoulder flexion, adduction, and abduction limitation.