The incidence of early upper extremity disability after axillary surgery in patients with early breast cancer

Date of Award


Document Type


Degree Name

Master of Medicine (MMed)


General Surgery (East Africa)


Background: The treatment of early breast cancer includes surgical removal of the tumor as well as evaluation of the axillary lymph node status. Axillary lymph node surgery, both sentinel lymph node biopsy and axillary lymph node dissection, is associated with upper arm morbidity that has been relatively understudied. The impact of this upper arm limitation has a direct effect on the patients’ quality of life. Determining the degree to which our patients experience this disability will enable the breast cancer unit to develop a prospective surveillance rehabilitative program.

Objectives: The objectives of the study were to determine the occurrence of upper extremity disability in patients with breast cancer undergoing axillary dissection, the relative risk of developing the above disability as quantified by a DASH score.

Methods: A cohort study was performed on 2 arms of patients; grouped into a ‘late’ arm, who had undergone axillary surgery up to 2 years prior, and an ‘early’ arm, comprising of patients who were recruited after they had undergone axillary surgery up to 6 weeks prior. Data was collected using the DASH® questionnaire.

Other variables including age and use of chemotherapy were collected. Data was analyzed using SPSS to correlate the extent of arm disability with specific activities on the DASH questionnaire.

Outcomes: The occurrence of upper extremity impairment with specific domains of the DASH score is presented.

Results: There was significant upper extremity limitation as measured by the DASH score, which ranged between 50 and 54 for both cohorts studied. The main disability domain comprised of neuropathic symptoms. There was no difference in the DASH scores between patients who underwent sentinel lymph node biopsy and those who had axillary lymph node dissection.

Conclusion: Patients undergoing treatment for early breast cancer experience limitations with their upper arm function. Interventions such as targeted rehabilitation program need to be offered as part of patient holistic care. Further longer term studies are required to quantify upper arm symptoms in this population

This document is available in the relevant AKU library