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Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection

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Abstract

Purpose

The objectives of this study were to electromyographically (EMG) describe and analyze factors associated with long thoracic nerve injuries in breast cancer patients after axillary lymph node dissection.

Methods

This was a prospective longitudinal observational study. Two hundred sixty-four women with primary invasive breast cancer were included between 2008 and 2011. All of them were treated by axillary lymph node dissection. Patients were evaluated at 1, 6, and 12 months following surgery. The presence of winged scapula was systematically tested at each follow-up and an EMG performed whenever it was observed. Affected and unaffected groups were compared for demographic, tumour, and treatment variables. Student t test, Mann–Whitney U test, chi-squared or Fisher test were computed as appropriate.

Results

Among the 36 (13.6 %) winged scapula observed, the EMG confirmed long thoracic nerve injury in 30 (11.3 %) of them, 27 were partial axonotmesis and three were severe axonotmesis. At 12 months, the EMG showed that injury persisted in six (2.27 %) patients. Patients with long thoracic nerve injury had a lower body mass index than unaffected patients (26.2 vs. 28.2, p = 0.045). Age, tumour stage, type of breast surgery, nodes excised, surgical complications, previous chemotherapy and previous hormonotherapy were not factors associated with winged scapula.

Conclusions

A lower body mass index was the only factor associated to long thoracic nerve injury. In most of the patients, the EMG showed partial axonotmesis. At 12 months, 2.27 % of studied patients remained with an unsolved long thoracic nerve injury.

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Conflict of interest

Authors declare that they have no conflict of interest.

Authors certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated. This study was sponsored by the hospital where authors work; there was any other external financial support.

Authors agree to allow the journal to review our data if requested.

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Authors and Affiliations

  1. Servei de Medicina Física i Rehabilitació, Hospital Mar-Esperança, C/ Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain

    Roser Belmonte, Sandra Monleon, Neus Bofill & Martha Ligia Alvarado

  2. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, 08193, Barcelona, Spain

    Roser Belmonte & Sandra Monleon

  3. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    Roser Belmonte

  4. Servei de Neurologia i Neurofisiologia Clínica, Hospital del Mar, Passeig Marítim de la Barceloneta, 24, 08003, Barcelona, Spain

    Josep Espadaler & Inmaculada Royo

Authors
  1. Roser Belmonte
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  2. Sandra Monleon
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  3. Neus Bofill
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  4. Martha Ligia Alvarado
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  5. Josep Espadaler
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  6. Inmaculada Royo
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Correspondence to Roser Belmonte.

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Belmonte, R., Monleon, S., Bofill, N. et al. Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection. Support Care Cancer 23, 169–175 (2015). https://doi.org/10.1007/s00520-014-2338-5

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  • DOI: https://doi.org/10.1007/s00520-014-2338-5

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