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Related Experiment Videos

Early versus delayed shoulder motion following axillary dissection: a randomized prospective study

M T Lotze, M A Duncan, L H Gerber

    Annals of Surgery
    |March 1, 1981
    PubMed
    Summary

    Starting physical therapy too soon after axillary dissection increases wound complications and drainage. Delaying range of motion (ROM) exercises for up to 7 days ensures adequate functional ROM with fewer complications.

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    Area of Science:

    • Oncology
    • Physical Therapy
    • Surgical Outcomes

    Background:

    • The optimal timing for physical therapy after axillary dissection for melanoma or mastectomy is not well-established.
    • Limited research exists on the role and timing of physical therapy interventions post-axillary dissection.

    Purpose of the Study:

    • To investigate the impact of early versus delayed initiation of physical therapy on wound healing and functional range of motion (ROM) after axillary dissection.
    • To compare postoperative physical therapy regimens in patients undergoing axillary dissection for melanoma and breast cancer.

    Main Methods:

    • A prospective randomized clinical trial involving 36 patients (40 axillary dissections) over 18 months.
    • Patients were randomized to either early (postoperative day 1) or delayed (postoperative day 7) initiation of range of motion (ROM) exercises.

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  • Data collected included wound drainage, days of drainage, hospital discharge day, wound complications, and functional ROM at 1, 3, and 6 months.

    • Main Results:

    • Early motion group experienced significantly more total wound drainage, longer drainage duration, and later discharge.
    • Wound complications (infection, skin breakdown) were more frequent in the early motion group (7 patients vs. 1 patient).
    • No significant differences in achieving functional ROM were observed between groups at 1, 3, or 6 months post-operation.

    Conclusions:

    • Early initiation of flexion and abduction exercises post-axillary dissection negatively impacts wound healing and drainage.
    • Delayed active motion exercises (up to 7 days) lead to adequate functional ROM with minimal complications.
    • Transient palsies (serratus anterior, latissimus dorsi) occurred in approximately 30% of patients, independent of the physical therapy regimen.