Neurodinamia del plexo braquial en el cáncer de mama
- Autores: Irene Rosa
- Directores de la Tesis: María Torres Lacomba (dir. tes.), Pedro de la Villa Polo (codir. tes.)
- Lectura: En la Universidad de Alcalá ( España ) en 2017
- Idioma: español
- Tribunal Calificador de la Tesis: Miguel Angel Pozo García (presid.), María José Yuste Sánchez (secret.), Roberto Cano de la Cuerda (voc.)
- Programa de doctorado: Programa de Doctorado en Ciencias de la Salud por la Universidad de Alcalá
- Materias:
- Enlaces
- Resumen
- español
Antecedentes: La cirugía axilar y el tratamiento coadyuvante del cáncer de mama pueden ocasionar daño en el tejido neural del miembro superior. La presente Tesis pretende conocer si el tejido neural está implicado en los síntomas de las mujeres tratadas de cáncer de mama, así como estudiar el comportamiento muscular durante la realización del test neurodinámico del nervio mediano (ULNT1) mediante el registro de la actividad mioeléctrica de los músculos circundantes a este nervio.
Sujetos y metodología: Se ha realizado un estudio descriptivo transversal en el que han participado 125 mujeres del Hospital de Torrejón, de las cuales 30 fueron intervenidas de cáncer de mama unilateral con linfadenectomía (LA), 32 fueron intervenidas de cáncer de mama unilateral con biopsia del ganglio centinela (BGC), y 63 eran mujeres sanas (C). Se realizó el ULNT1 así como una maniobra de sensibilización neural para determinar si el test era positivo. Se registró la actividad mioeléctrica de los músculos bíceps braquial y tríceps braquial y se tomaron medidas goniométricas del rango de movimiento de abducción, rotación externa de hombro y del déficit de extensión de codo en los tres tiempos de medida durante la realización del ULNT1: 1) aparición de la tensión; 2) aumento la amplitud de la actividad muscular; y 3) máxima resistencia muscular. Se estudió la normalidad de la muestra mediante los tests de Kolmogorov-Smirnov y Shapiro-Wilk, y se utilizaron la prueba de chicuadrado de Pearson y el test de ANOVA de una vía para observar las diferencias inter-grupos. Las comparaciones múltiples de las variables cuantitativas se estudiaron con el test de Bonferroni.
Resultados: El 100% de las mujeres de los grupos de cáncer de mama presentaron un ULNT1 positivo. Los grupos de cáncer de mama presentaron un incremento de la actividad mioeléctrica del músculo bíceps braquial en comparación con el grupo control, de un 39% en el grupo LA y un 49% en el grupo BGC en el tiempo de aparición de la tensión. Sin embargo, en el músculo tríceps braquial el incremento fue significativo sólo en el grupo BGC, que en comparación con el grupo C fue de un 15% y en comparación con el grupo LA de un 11,5% en el tiempo de aparición de la tensión.
Conclusiones: El tejido neural está implicado en los síntomas de las mujeres tratadas de cáncer de mama y la mecanosensibilidad neural del plexo braquial está incrementada, mostrando un incremento de la respuesta protectora muscular del músculo bíceps braquial en comparación con mujeres sanas. La respuesta protectora del músculo tríceps braquial parece verse influida por el tipo de cirugía axilar, ya que las mujeres intervenidas con BGC han presentado una mayor actividad mioeléctrica.
- English
Background: Nowadays breast cancer surgery implies less morbidity thanks to a conservative and less aggressive approach. Nevertheless, pain is still one of the recurrent effects subsequent to breast cancer treatment but it is the least known. The pain revealed after the treatment is a result of several factors, like psychological factors -such as anxiety and depression- as well as therapeutic factors -such as axillary surgery, radiotherapy, and chemotherapy. These three latter therapeutic procedures may lead to neural tissue damage, which implies a mechanical threshold drop and, consequently, an increased mechanosensitivity. This Thesis aims to know if neural tissue is involved in breast cancer survivors´ symptoms as well as to study the muscle behavior within the upper limb neurodynamic test 1 by recording the myoelectric activity from the muscles that surround the median nerve. Subjects and methods: A cross-sectional descriptive study was conducted over 125 women from Hospital de Torrejon, in which the data assessors were blinded. Regarding the breast cancer women survivors who participated, 30 out of 125 had undergone unilateral breast cancer surgery with lymphadenectomy, 32 women had undergone unilateral breast cancer surgery with sentinel lymph node biopsy; and 63 women were healthy –control group. Each healthy women was in matched with a breast cancer woman according to age and handedness. Those women whose surgery had taken place one and half year before were excluded. Likewise, those under bilateral breast cancer or with any upper limb pathology on the ipsilateral side prior to surgery. Healthy women were excluded as well if they suffered from either neck or ipsilateral shoulder pain or any chronic pain condition. Firstly, pain was assessed by descriptors showed in Leeds Assessment of Neuropathic Symptoms and Signs scale (LANSS) as well as by body mapping. Secondly, the upper limb neurodynamic test 1 and also a sensitizing maneuver were performed to determine if the test was positive. Lastly, the upper limb neurodynamic test 1 so that the biceps brachii and triceps brachii myoelectic activity were recorded. Besides, goniometric measures were performed for shoulder abduction, shoulder external rotation and elbow extension deficit in the three different times of measure within the upper limb neurodynamic test 1: 1) the time of onset tightness; 2) the time of myoelectric activity increase; 3) the time of maximal muscle resistance. The Statistical Package for the Social Sciences software (SPSS) was used for the statistical analysis. The Kolmogorov-Smirnov and Shapiro-Wilk tests were used to assess normal distribution, and the Pearson’s chi-squared test and one way ANOVA test were conducted to determine whether the three groups differed on the demographic variable (age) and sample characteristics. Three separate one-way ANOVA (for tightness onset, evoked-myoelectric activity increase and maximal muscle resistance) were conducted to analyze differences in myoelectric activity of biceps and triceps brachii, abduction range of motion, external rotation range of motion and elbow extension range of motion deficit. Post- hoc multiple analyses for bivariate comparisons were made by using Bonferroni test.
Results: As already stated above, data from 125 women was analyzed, 62 breast cancer women and 63 healthy women. The sample depicted homogeneity in terms of demographic variable and participants characteristics. However, chemotherapy variable was not balanced between breast cancer groups. The 100% of breast cancer women showed a positive sensitizing maneuver.
Both breast cancer groups showed an increase in biceps brachii myolectrical activity compared with control group at the time of onset tightness: 39% increase in the lymphadenectomy group and 49% in the sentinel lymph node biopsy group. Besides, both breast cancer groups differed with healthy women in the muscle recruitment pattern of biceps brachii. Yet the triceps brachii showed a significant myoelectric activity growth only in sentinel node biopsy group at the time of onset tightness: 15% compared with control group and 11.5% with the lymphadenectomy group. Relating to muscle recruitment pattern of triceps brachii, sentinel biopsy group differed with lymphadenectomy and control groups. Both breast cancer groups showed a range of motion restriction on shoulder abduction and external rotation as well as an increase in elbow extension deficit. The most frequent type of pain among breast cancer women was disesthesic neuropathic pain. It was referred by the 96,67% of women from lymphadenectomy group and by the 75,01% of women from sentinel lymph node biopsy group. The medial aspect of the arm was the most common area where the pain was located (the 63,33% of women from lymphadenectomy group and the 59,39% of women from sentinel lymph node biopsy group).
Conclusions: Neural tissue is involved in the breast cancer survivor’s symptoms. Indeed, they undergo an increased brachial plexus mechanosensitivity through the upper limb neurodynamic test 1, showing a biceps brachii increased protective response comparing with healthy women.
Regarding the triceps brachii protective response it seems to be affected by the kind of axillary surgery performed, since sentinel lymph node biopsy group have shown an increased myoelectrical activity in compare with both control group and lymphadenectomy group.
Moreover, biceps brachii shows a regressive-ascendant recruitment pattern among breast cancer women whereas it shows a progressive-ascendant recruitment pattern among healthy women. The muscle recruitment pattern of triceps brachii is stable-ascendant among women who underwent sentinel lymph node biopsy whereas it is regressive-ascendant among women who underwent lymphadenectomy as well as healthy women.
- español
