Background In Mexico, breast cancer (BC) is the second leading cause of death from tumor processes in women over 25 years. It is estimated that by 2020 this group will reach 38.8 million (one third of the total population). Since the mastectomy involves shoulder neuromusculoskeletal tissue, can be understood why BC survivors develop alterations in the shoulder as weakness, fatigue, decrease of motion and lymphedema (1). When presented with chronic lymphedema, symptoms of upper limb patients includes limitation on movement, pain, stiffness and weakness. Jeong et al (2) demonstrated in a pilot study which included 39 patients diagnosed with BC and mastectomy that 71% of the patients had shoulder pain, and of these 39.5% had ultrasonographic abnormalities which included the tear-drop sign in supraspinatus, biceps tenosynovitis, acromioclavicular arthritis subdeltoid bursitis.
Objectives Identify existing ultrasound (US) abnormalities on the shoulders of consecutive patients with BC and mastectomy at the Oncology department of the Centenario Hospital Miguel Hidalgo.
Methods Consecutive patients of the Oncology department with a history of BC and mastectomy. Patients with shoulder pain prior to diagnosis of BC, history of neck and upper limbs trauma and who did not accept to participate in the study were excluded. Shoulder US was performed bilaterally with an Esaote MyLab 25 (Genoa, Italy) US machine and a multi-frequency linear probe (10-18 MHz). Sociodemographic data were recorded and a questionnaire of functional assessment of the shoulder (Shoulder Disability Questionnaire, SDQ) was applied.
Results We included 34 women with a mean age of 57.3 ± 11.8 years, BMI 29.84 ± 7.03, right mastectomy in 16, left in 17 and bilateral in 1. The time since the surgery had an average of 1.9 years (range 1-9). Twenty-two patients (64%) reported shoulder pain (SDQ: affirmative answers mean=9, range 1-14). In these 22 patients US was normal in 7 (31%), the remaining 15 (69%) showed: partial or complete tear of the supraspinatus (6), bicipital tenosynovitis (4), subacromial bursitis (3), acromioclavicular arthritis (3), subscapularis tendinopathy (3), irregularities of the humeral head (2), supraspinatus tendinopathy (1), capsulitis (1) and tendon calcification (1). In 4 (33%) of the 12 patients without pain the US was normal. The 8 (67%) remaining patients had partial or complete tear of the supraspinatus (4), bicipital tenosynovitis (2), subacromial bursitis (2), supraspinatus tendinopathy (1) and irregularities of the humeral head (1).
Conclusions The findings of our study show that more than half of the patients (69%) underwent mastectomy with BC will develop US abnormalities in the shoulder (mainly the rotator cuff) as a complication of their condition. Even in patients without pain is possible to find US pathology (67%), which makes imperative to conduct studies with larger numbers of patients and long-term monitoring.
Nesvold IL, Reinertsen KV, Fosså SD, Dahl AA. The relation between arm/shoulder problems and quality of life in breast cancer survivors: a cross-sectional and longitudinal study. J Cancer Surviv. 2011;5:62-72.
Jeong HJ, Sim YJ, Hwang KH, Kim GC. Causes of shoulder pain in women with breast cancer-related lymphedema: a pilot study. Yonsei Med J. 2011;52:661-7.
Disclosure of Interest None Declared