AB1073 The effects of lymphedema severity on dynamic scapular control
Authors: E. Baran, T.I. Yıldız, C. Orhan, E. Üzelpasacı, S. Özgül, I. Düzgün, T. Akbayrak
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Women with mastectomy are reported to have altered dynamic scapular control compared to the asymptomatic healthy individuals. However, the effects of breast cancer related lymphedema (LE) on scapular control has not been fully understood yet.<sup>1, 2</sup> <h3>Objectives</h3> The aim of this study was to determine the impact of LE severity on scapular kinematics in breast cancer patients with moderate LE, severe LE and without LE. <h3>Methods</h3> 67 women who have undergone radical or modified radical mastectomy as part of the breast cancer treatment were included in the study. The study was approved by the local ethics committee of the university and all participants provided written informed consent. Individual's demographic and medical characteristics were recorded. By volumetric measurement, women were divided into 3 groups. Between the affected and non-affected extremities; the non-LE group (group 1, n=22) had 0 and 200cc difference, the moderate LE group (group 2, n=18) had 250–500cc difference, and the severe LE group (group3, n=27) had a difference of 500cc or more. 3-D analysis of the scapula was performed during the bilateral upper extremity elevation in the scapular plane with the 3D Motion Monitor-Electromagnetic System. Scapular kinematics in the scapular plane were recorded at 30°, 60° and 90° (during elevation and lowering phases) of the arm elevation in the affected side. Each measurement was repeated 3 times and the mean of 3 repetitions were recorded. Patient characteristics and scapular kinematics were analysed by Kruskal Wallis test and two-way repeated measures of ANOVA test, respectively. <h3>Results</h3> There was no significant difference between groups in terms of age (mean ages; group 1: 45.54±5.88, group 2: 52.05±6.63, group 3: 56.37±8.24 years) (p=0.08). Regarding the Body Mass Index (BMI) (group 1: 25.57±2.92, group 2: 25.95±2.35, group 3: 28.93±1.02 kg/m<sup>2</sup>), it was found that group 3 had higher BMI scores than group 1 and 2 (p&lt;0.001). The duration of LE (group 2: 22.38±23.1, group 3: 42.29±31.85 months) was higher in group 3 than the group 2 (p=0.004). There were significant interactions for scapular upward rotation between groups (F<sub>4.11, 131.51</sub> =3.09, p=0.015). It was observed that group 1 had higher scapular upward rotation at 60° and 30° of the lowering phase of the arm elevation trials than group 3 (p=0.013, p=0.004). There was no significant interaction in terms of the scapular internal rotation (F<sub>4.37, 139.9</sub>=0.59, p&gt;0.05) and posterior tilt ((F<sub>5.05, 161.8</sub> =1.02, p=0.4) among groups during the arm elevation in scapular plane. <h3>Conclusions</h3> The results of this study revealed that scapular upward rotation could be reduced by LE severity. LE severity might also be associated with BMI and LE duration. Further studies comparing LE patients with healthy individuals are needed to better understand the effects of LE severity on scapular kinematics. <h3>References</h3> [1] Shamley D, Srinaganathan R, Oskrochi R, Lascurain-Aguirrebena I, Sugden E. Three-dimensional scapulothoracic motion following treatment for breast cancer. Breast cancer research and treatment. 2009;118(2):315–22. [2] Crosbie J, Kilbreath SL, Dylke E, Refshauge KM, Nicholson LL, Beith JM, et al. Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement. Physical therapy. 2010;90(5):679–92. <h3>Disclosure of Interest</h3> None declared