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2006 SAE-P: Upper-Extremity Pain Disorders in Breast Cancer Answer Key and Commentary on Preferred Choice
S101
2006 SAE-P: Upper-Extremity Pain Disorders in Breast Cancer Answer Key and Commentary on Preferred Choice QUESTION 1.
ANSWER (c)
2.
(c)
3.
(c)
4.
(b)
5.
(d)
COMMENTARY There are few studies and limited information regarding specific etiologies of pain and musculoskeletal complaints in patients with breast cancer. Taxanes are commonly used to treat breast cancer and can result in neuropathy. Nerve stabilizers are effective in relieving positive symptoms such as pain and paresthesias but they will not alleviate numbness, weakness, or proprioceptive deficits. Chemotherapyinduced neuropathies typically present in a distal symmetric distribution. Patients with preexisting neuropathy may be more likely to develop neuropathic signs and symptoms when treated with neurotoxic chemotherapy. The modality of choice in evaluating the brachial plexus to rule out breast cancer recurrence is magnetic resonance imaging. Noninvasive evaluation is preferable to biopsy in this instance. Electrodiagnostic testing will evaluate the plexopathy but will not determine the source. CA 125 is a tumor marker that is used to monitor patients with breast cancer but this, too, does not specifically determine the source of the plexopathy. Needle electromyography is generally safe in patients with lymphedema. Deep heating modalities, although contraindicated in primary tumors, are unlikely to worsen metastatic disease and therefore warming of the limb before electrodiagnostic evaluation is acceptable. Brachial plexopathy is generally a late complication of radiation therapy. Long thoracic nerve injury may occur during mastectomy. This causes serratus anterior weakness and impaired scapular stabilization but no rotator cuff tendonitis. All of the other choices are associated with rotator cuff weakness and tendonitis.
Arch Phys Med Rehabil Vol 87, Suppl 1, March 2006
2006 SAE-P: Upper-Extremity Pain Disorders in Breast Cancer Answer Key and Commentary on Preferred Choice QUESTION 1.
ANSWER (c)
2.
(c)
3.
(c)
4.
(b)
5.
(d)
COMMENTARY There are few studies and limited information regarding specific etiologies of pain and musculoskeletal complaints in patients with breast cancer. Taxanes are commonly used to treat breast cancer and can result in neuropathy. Nerve stabilizers are effective in relieving positive symptoms such as pain and paresthesias but they will not alleviate numbness, weakness, or proprioceptive deficits. Chemotherapyinduced neuropathies typically present in a distal symmetric distribution. Patients with preexisting neuropathy may be more likely to develop neuropathic signs and symptoms when treated with neurotoxic chemotherapy. The modality of choice in evaluating the brachial plexus to rule out breast cancer recurrence is magnetic resonance imaging. Noninvasive evaluation is preferable to biopsy in this instance. Electrodiagnostic testing will evaluate the plexopathy but will not determine the source. CA 125 is a tumor marker that is used to monitor patients with breast cancer but this, too, does not specifically determine the source of the plexopathy. Needle electromyography is generally safe in patients with lymphedema. Deep heating modalities, although contraindicated in primary tumors, are unlikely to worsen metastatic disease and therefore warming of the limb before electrodiagnostic evaluation is acceptable. Brachial plexopathy is generally a late complication of radiation therapy. Long thoracic nerve injury may occur during mastectomy. This causes serratus anterior weakness and impaired scapular stabilization but no rotator cuff tendonitis. All of the other choices are associated with rotator cuff weakness and tendonitis.
Arch Phys Med Rehabil Vol 87, Suppl 1, March 2006