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Scapular winging in surgical treatment of breast cancer, prospective study to optimize the follow-up protocol

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Abstract

Introduction

One of the most common complications of the surgical treatment of breast cancer is limited range-of-motion in the shoulder. Scapular winging is one of the most underdiagnosed shoulder mobility impairments.

Objective

The main objective of this study was to determine the incidence of scapular winging in patients who underwent breast cancer surgery as the basis for expanding the protocol to patients who have had a sentinel lymph node biopsy. The secondary objective was to determine the risk factors that lead to the development of a winged scapula presented after breast cancer treatment in our sample.

Methods

This was a prospective, observational, and multidisciplinary study. Between 2013 and 2018, 214 consecutive patients who had been diagnosed with breast cancer and treated for it surgically were followed by Rehabilitation Department for 3 years. The patients were evaluated in the 1st, 6th, 12th, 18th, 24th and 36th months following surgery. Scapular winging was evaluated at each visit by means of static and dynamic tests.

Results

The cumulative incidence of scapular winging was 3.6% and seven cases of winged scapula were diagnosed. All the cases were diagnosed at the first visit, 1 month after the intervention. In the univariate analysis, the axillary lymph node dissection technique was a more significant risk factor for a winged scapula than sentinel lymph node biopsy.

Conclusions

The axillary lymph node dissection technique is a risk factor for developing a winged scapula. No evidence was found for any other significant risk factor.

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Abbreviations

ALND:

Axillary lymph node dissection

SLNB:

Sentinel lymph node biopsy

BMI:

Body mass index

LTN:

Long thoracic nerve

SD:

Standard deviations

HZ:

Hazard ratio

CI:

Confidence interval

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Acknowledgements

The authors would like to thank M.LL.C and A.G.T who conceived the study, all the resident doctors who collected the data and the Gynecology and Plastic Surgery Dept. of Hospital Universitari de Bellvitge for providing the patients.

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Authors and Affiliations

  1. Department of Rehabilitation, Hospital Universitari Bellvitge, Carrer de la Feixa Llarga, s/n, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    M. Ortí-Asencio, S. Salinas-Huertas, A. Luzardo-González, J. Terra-Falótico & R. Planas-Balagué

  2. Universitat de Barcelona, Barcelona, Spain

    R. Planas-Balagué

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  1. M. Ortí-Asencio
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  2. S. Salinas-Huertas
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Correspondence to M. Ortí-Asencio.

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The authors declare that they have no conflict of interest. The authors certify that neither party has a direct interest in the results of the research that supports this article, or does it benefit us or any organization with which we are associated with. This study was sponsored by the hospital where the authors work. There was no external financial support. The authors agree to allow the journal to review our data if requested.

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Ortí-Asencio, M., Salinas-Huertas, S., Luzardo-González, A. et al. Scapular winging in surgical treatment of breast cancer, prospective study to optimize the follow-up protocol. Clin Transl Oncol 23, 2090–2098 (2021). https://doi.org/10.1007/s12094-021-02612-x

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