# A Retrospective Analysis of Correlations Between Shoulder Impairment and Ultrasound Lymphedema Evaluation in Breast Cancer Patients: Preliminary Results

## TL;DR

This study explores how shoulder problems in breast cancer patients are linked to lymphedema using ultrasound and clinical assessments.

## Contribution

The study presents preliminary evidence linking shoulder impairment with ultrasound-detected lymphedema in breast cancer patients.

## Key findings

- Lymphedema was found in 35.7% of patients and was associated with higher BMI and limited shoulder movement.
- Ultrasound measurements showed preliminary agreement with traditional circumferential measurements for lymphedema detection.
- Patients with lymphedema had higher DASH scores and more AWS occurrences.

## Abstract

Background/Objective: Breast cancer-related lymphedema (BCRL) is a frequent postoperative complication associated with shoulder functional impairment. Early diagnosis and comprehensive assessment are recommended, yet the literature shows heterogeneity regarding instrumental tools and the role of soft tissue ultrasound is not yet standardized. The aim of this retrospective observational study is to evaluate correlations between shoulder impairment and lymphedema in breast cancer patients. Methods: Medical records of 27 outpatient women after breast cancer surgery (mean age ± SD: 55.10 ± 9.58) were evaluated. Clinical variables included anamnestic data regarding surgery and oncology treatments, limb circumferences, passive shoulder range of motion (PROM), axillary web syndrome (AWS) and BMI. Assessment tools included DASH, ECOG, and VAS. Millimetric ultrasound measurements of the dermo-epidermal complex and subcutaneous tissue, at standardized sites, were performed to study limb lymphedema. Results: Lymphedema was found in 35.7% of patients. They showed higher rates of lymphadenectomy, AWS, higher BMI, limited shoulder flexion (p = 0.002) and abduction (p = 0.004), and higher DASH scores (31.99 ± 15.70 vs. 26.16 ± 17.8) compared with patients without lymphedema. There was a preliminary correspondence between circumferential and ultrasound measurement sites of patients’ lymphedema limbs. Conclusions: Ultrasound evaluation associated with functional assessment may support the early diagnosis of shoulder impairment and higher limb lymphedema risk to improve rehabilitation treatments in patients after breast cancer surgery.