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Long Term Effects of Complex Decongestive Therapy in Breast Cancer Patients with Arm Lymphedema after Axillary Dissection
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Disclosures: S. K. Chu, No Disclosures: I Have Nothing To Disclose. Case Description: A 57-year-old man presented with right knee stiffness, pain and quadriceps weakness. The patient had a fall 18 months prior resulting in a right patellar dislocation. X-rays of the right knee taken in the ED were negative. The patient was placed in a knee immobilizer and had an MRI that showed evidence of right lateral patellar dislocation and degenerative medial meniscal tear. He was given a patellofemoral brace and referred to physical therapy. He continued to have right quadriceps weakness and knee stiffness that limited his return to cycling and running. Setting: Outpatient clinic. Results or Clinical Course: Examination was significant for loss of end-range extension in right knee when standing. Gait was notable for decreased knee flexion in swing, decreased knee extension and time spent on right leg during stance phase. There was no effusion. He had tenderness to palpation of right peripatellar structures and decreased sensation in right medial knee and proximal calf. Lower extremity reflexes were equal and symmetric. Strength testing was 5/5 throughout, except for 4/5 with resisted knee extension. He was unable to perform a single leg sit to stand on the right. There was moderate loss of end-range active knee extension on right, but passive extension was full. Right quadriceps atrophy was observed. Tests for ligamentous laxity and meniscal tears were negative. X-rays of the right knee demonstrated a mild irregularity of the medial patellar facet, no significant degenerative changes. EMG/NCS showed evidence of a right axonal motor femoral neuropathy. MR neurography of the right lower limb was negative for lesions along the right femoral nerve or significant fatty atrophy of the quadriceps muscles. The patient was referred for additional physical therapy focused on active knee extension and closed kinetic chain strengthening. He was able to return to cycling and jogging. Discussion: This is an unusual case of femoral neuropathy after patellar dislocation. There is only one other case in the literature involving a dancer in the setting of recurrent patellar subluxations. We suspect that the mechanism was a stretch injury to the femoral nerve related to the knee position during his fall. Conclusions: A co-existing femoral neuropathy should be considered patients with prolonged recovery after patellar dislocation. Poster 239 Long Term Effects of Complex Decongestive Therapy in Breast Cancer Patients with Arm Lymphedema after Axillary Dissection. Jung Min Hwang (Samsung Medical Center, Seoul, Korea, Republic of); Ji Hye Hwang, MD, PhD; Tae Won Kim, Doctor; Hyun Ju Chang, Master; In Ho Chu, PT. Disclosures: J. Hwang, No Disclosures: I Have Nothing To Disclose. Objective: The purpose of this study was to investigate the effects of complex decongestive therapy (CDT) for 24 months on edema reduction in patients with arm lymphedema after an axillary dissection. We investigated the difference in the maintenance of volume reduction according to the amount of initial edema volumes. Setting: A retrospective review of 57 patients with unilateral arm lymphedema after an axillary dissection for breast cancer was
PRESENTATIONS
performed. The edema of the patients treated with two weeks of CDT and self-administered home therapy was followed for 24 months. Arm volume was serially measured by using an optoelectric volumeter prior to and immediately after CDT, and there were follow-up visits at 3, 6, 12 and 24 months. Patients were divided into two groups according to the percent excess volume (PEV) prior to CDT: Group 1 ¼ PEV < 20 %; Group 2 ¼ PEV 20%. The long term effects of CDT on edema reduction were compared in Group 1 and Group 2. Results or Clinical Course: At the end of CDT, PEV was 28.8% in Group 2 which was significantly lower than the baseline (41.9%). The reduction of PEV was maintained for 24 months in Group 2. On the other hand, in follow-up examinations, Group 1 patients did not reveal a significant increase in PEV. Conclusions: This study suggests that the long term edema reducing effects of CDT were well maintained for 24 months. Both groups showed continuous responses and the patients with more initial PEV showed better edema reducing effects of CDT. In the long term (24 months), CDT was found to be effective in reducing arm lymphedema after surgery for breast cancer. Poster 240 Persistent Bilateral Peroneal Neuropathy Associated with Chronic Exertional Compartment Syndrome: A Case Report. Michael J. Burns, MD (Stanford University, Redwood City, CA, United States). Disclosures: M. J. Burns, No Disclosures: I Have Nothing To Disclose. Case Description: A 29-year-old Caucasian man was referred for electromyography (EMG) and nerve conduction studies (NCS) with 3 years of bilateral lower extremity pain. The onset of pain first occurred during military basic training. He reported chronic bilateral lower extremity symptoms including: lateral shin pain, numbness, swelling, and right greater than left foot drop which increased with activity such as running. The patient was found to have 5/5 strength in all myotomes and motor nerve distributions with the exception of the bilateral ankle dorsiflexors (ADF) which demonstrated 4/5 strength. After jogging for 5 minutes, the patient’s ADF strength was noted to decrease to 2/5 with strength in other muscle groups preserved. He reported moderately decreased sensation in the superficial peroneal nerve distribution bilaterally when compared to the deep peroneal, sural, and saphenous nerves. Previous MRI of the lumbar spine demonstrated no focal spinal cord abnormality or signs of neuroforaminal stenosis. EMG/NCS were normal with the following exceptions: 1. right peroneal compound muscle action potential (CMAP) to the extensor digitorum brevis (EDB) demonstrated a moderately prolonged distal latency and a 41% drop in CMAP amplitude compared to the left peroneal CMAP, 2. left superficial peroneal nerve demonstrated a sensory nerve action potential (SNAP) 45% of the superficial peroneal SNAP measured on the right, 3. EMG of the right tibialis anterior demonstrated rare volitional MUAP with increased amplitude. No abnormal spontaneous insertional activity was detected. Setting: Outpatient clinic. Results or Clinical Course: The patient was referred to Orthopedic Surgery for compartment pressure measurement and underwent bilateral anterior and lateral fasciotomy with resolution
Disclosures: S. K. Chu, No Disclosures: I Have Nothing To Disclose. Case Description: A 57-year-old man presented with right knee stiffness, pain and quadriceps weakness. The patient had a fall 18 months prior resulting in a right patellar dislocation. X-rays of the right knee taken in the ED were negative. The patient was placed in a knee immobilizer and had an MRI that showed evidence of right lateral patellar dislocation and degenerative medial meniscal tear. He was given a patellofemoral brace and referred to physical therapy. He continued to have right quadriceps weakness and knee stiffness that limited his return to cycling and running. Setting: Outpatient clinic. Results or Clinical Course: Examination was significant for loss of end-range extension in right knee when standing. Gait was notable for decreased knee flexion in swing, decreased knee extension and time spent on right leg during stance phase. There was no effusion. He had tenderness to palpation of right peripatellar structures and decreased sensation in right medial knee and proximal calf. Lower extremity reflexes were equal and symmetric. Strength testing was 5/5 throughout, except for 4/5 with resisted knee extension. He was unable to perform a single leg sit to stand on the right. There was moderate loss of end-range active knee extension on right, but passive extension was full. Right quadriceps atrophy was observed. Tests for ligamentous laxity and meniscal tears were negative. X-rays of the right knee demonstrated a mild irregularity of the medial patellar facet, no significant degenerative changes. EMG/NCS showed evidence of a right axonal motor femoral neuropathy. MR neurography of the right lower limb was negative for lesions along the right femoral nerve or significant fatty atrophy of the quadriceps muscles. The patient was referred for additional physical therapy focused on active knee extension and closed kinetic chain strengthening. He was able to return to cycling and jogging. Discussion: This is an unusual case of femoral neuropathy after patellar dislocation. There is only one other case in the literature involving a dancer in the setting of recurrent patellar subluxations. We suspect that the mechanism was a stretch injury to the femoral nerve related to the knee position during his fall. Conclusions: A co-existing femoral neuropathy should be considered patients with prolonged recovery after patellar dislocation. Poster 239 Long Term Effects of Complex Decongestive Therapy in Breast Cancer Patients with Arm Lymphedema after Axillary Dissection. Jung Min Hwang (Samsung Medical Center, Seoul, Korea, Republic of); Ji Hye Hwang, MD, PhD; Tae Won Kim, Doctor; Hyun Ju Chang, Master; In Ho Chu, PT. Disclosures: J. Hwang, No Disclosures: I Have Nothing To Disclose. Objective: The purpose of this study was to investigate the effects of complex decongestive therapy (CDT) for 24 months on edema reduction in patients with arm lymphedema after an axillary dissection. We investigated the difference in the maintenance of volume reduction according to the amount of initial edema volumes. Setting: A retrospective review of 57 patients with unilateral arm lymphedema after an axillary dissection for breast cancer was
PRESENTATIONS
performed. The edema of the patients treated with two weeks of CDT and self-administered home therapy was followed for 24 months. Arm volume was serially measured by using an optoelectric volumeter prior to and immediately after CDT, and there were follow-up visits at 3, 6, 12 and 24 months. Patients were divided into two groups according to the percent excess volume (PEV) prior to CDT: Group 1 ¼ PEV < 20 %; Group 2 ¼ PEV 20%. The long term effects of CDT on edema reduction were compared in Group 1 and Group 2. Results or Clinical Course: At the end of CDT, PEV was 28.8% in Group 2 which was significantly lower than the baseline (41.9%). The reduction of PEV was maintained for 24 months in Group 2. On the other hand, in follow-up examinations, Group 1 patients did not reveal a significant increase in PEV. Conclusions: This study suggests that the long term edema reducing effects of CDT were well maintained for 24 months. Both groups showed continuous responses and the patients with more initial PEV showed better edema reducing effects of CDT. In the long term (24 months), CDT was found to be effective in reducing arm lymphedema after surgery for breast cancer. Poster 240 Persistent Bilateral Peroneal Neuropathy Associated with Chronic Exertional Compartment Syndrome: A Case Report. Michael J. Burns, MD (Stanford University, Redwood City, CA, United States). Disclosures: M. J. Burns, No Disclosures: I Have Nothing To Disclose. Case Description: A 29-year-old Caucasian man was referred for electromyography (EMG) and nerve conduction studies (NCS) with 3 years of bilateral lower extremity pain. The onset of pain first occurred during military basic training. He reported chronic bilateral lower extremity symptoms including: lateral shin pain, numbness, swelling, and right greater than left foot drop which increased with activity such as running. The patient was found to have 5/5 strength in all myotomes and motor nerve distributions with the exception of the bilateral ankle dorsiflexors (ADF) which demonstrated 4/5 strength. After jogging for 5 minutes, the patient’s ADF strength was noted to decrease to 2/5 with strength in other muscle groups preserved. He reported moderately decreased sensation in the superficial peroneal nerve distribution bilaterally when compared to the deep peroneal, sural, and saphenous nerves. Previous MRI of the lumbar spine demonstrated no focal spinal cord abnormality or signs of neuroforaminal stenosis. EMG/NCS were normal with the following exceptions: 1. right peroneal compound muscle action potential (CMAP) to the extensor digitorum brevis (EDB) demonstrated a moderately prolonged distal latency and a 41% drop in CMAP amplitude compared to the left peroneal CMAP, 2. left superficial peroneal nerve demonstrated a sensory nerve action potential (SNAP) 45% of the superficial peroneal SNAP measured on the right, 3. EMG of the right tibialis anterior demonstrated rare volitional MUAP with increased amplitude. No abnormal spontaneous insertional activity was detected. Setting: Outpatient clinic. Results or Clinical Course: The patient was referred to Orthopedic Surgery for compartment pressure measurement and underwent bilateral anterior and lateral fasciotomy with resolution