Physical Therapy Approach in Shoulder Impairment Along With Lymphedemea after Breast Cancer Surgery: A Case Study

A 52-year-old woman with a history of breast cancer and mastectomy surgery and axillary lymph nodes dissection was referred to a physical therapy clinic. Lymphotherapist assessment revealed that there was a grade II upper limb lymph edema; pitting and palpable fibrotic tissue existed in volar side of forearm. Water displacement measurement to assess the limb volume in affected and unaffected side indicated an obvious difference. In physical examination, there was a significant limitation in shoulder range of motion (ROM) and tightness in shoulder girdle muscles. A multimodal physical approach based on manual therapy, electrotherapy and exercise therapy was conducted to eliminate shoulder impairment along with Manual Lymph Drainage (MLD) and lymphological compression bandage to eliminate lymphedema. The results of final re- assessment indicated that combination of lymphatic massage and compression bandage can lower the lymph edema following the mastectomy. Also, physical therapy approach can reduce the symptoms of shoulder disability caused by mastectomy and lymph nod dissection surgery. It should be taken into account that in patients who are suffering from lymph edema, recovering the shoulder movements and early return to normal function are very effective in improving lymph flow and reducing edema. Therefore, by restoring shoulder movement, in addition to reducing shoulder pain and increasing performance, can improve lymph flow as well among these patients.