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Shoulder function after latissimus dorsi transfer in breast reconstruction
B Forthomme1, O Heymans, D Jacquemin
1Department of Motricity Sciences, University and CHU of Liege Service of Plastic Surgery, University and CHU of Liege, Liege, Belgium. bforthomme@ulg.ac.be
Clinical Physiology and Functional Imaging
|July 17, 2010
Summary
Latissimus dorsi (LD) transfer for breast reconstruction causes shoulder weakness, particularly in adductor and internal rotator muscles. Specific shoulder strengthening exercises are recommended post-surgery to improve function.
Area of Science:
- Orthopedics
- Plastic Surgery
- Reconstructive Surgery
Background:
- Latissimus dorsi (LD) transfer is a common technique for breast reconstruction due to ample tissue availability.
- The functional consequences of LD muscle removal on shoulder strength and performance are not fully understood.
Purpose of the Study:
- To investigate the impact of unilateral LD transfer on shoulder function and maximal muscle strength.
- To evaluate the development of muscular deficits and agonist/antagonist muscle imbalances post-surgery.
Main Methods:
- Twenty women undergoing unilateral LD transfer for breast reconstruction were assessed pre-surgery and 3 and 6 months post-surgery.
- Bilateral shoulder isokinetic assessments evaluated internal rotators (IRs), external rotators, abductors, and adductors (ADDs).
- Shoulder algofunctional and clinical status were analyzed using the Constant score and specific clinical tests.
Main Results:
- Significant muscle weakness was observed 3 and 6 months post-LD transfer, predominantly in ADDs (33% deficit at 6 months) and IRs (16% deficit at 6 months).
- The Constant score significantly decreased for the operated shoulder, correlating with pain during clinical tests.
- A correlation was found between Constant score impairment and IR weakness or rotator muscle imbalance.
Conclusions:
- LD transfer leads to measurable shoulder muscle weakness and functional decline.
- Specific shoulder strengthening exercises, focusing on internal rotators and adductors, are recommended after LD transfer for breast reconstruction.
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