PHYSIOTHERAPEUTIC MANAGEMENT POST RADICAL MASTECTOMY.pptx

radical mastectomy is a disabling condition, the side effects and post surgical complications of the conditions affect the patient both physically, psychologically and socially. in this presentation, an attempt to cover problem list, do's and don'ts, assessment, management is explained in detail.

1. DATTA MEGHE COLLEGE OF PHYSIOTHERAPY . DEPARTMENT OF CARDIOPULMONARY SCIENCES

2. PHYSIOTHERAPEUTIC MANAGEMENT POST- RADICAL MASTECTOMY. DR. SACHIN CHAUDHARY MPT (Cardio- R espi . Physiotherapy) PROFESSOR & HEAD DATTA MEGHE COLLEGE OF PHYSIOTHERAPY NEHA INGALE CHAUDHARY MPT (Neuro) PROFESSOR & HEAD DATTA MEGHE COLLEGE OF PHYSIOTHERAPY

3. PREFACE This PPT is intended primarily for Bachelor of Physiotherapy (BPTh) Final year students those are under preparation for their University Examination. I have attempted to cover different areas of mastectomy management. Despite my best efforts there might have some errors. I like to thank all those who have helped me. Dr. Sachin Chaudhary ,Dr. Neha Ingale Chaudhary

4. CONTENT Sr. No. Topic Slide No 1 Objectives and content 5-7 2 Introduction and Types of mastectomy 8-17 3 Problem list 18-19 4 Physiotherapeutic assessment of post radical mastectomy condition 20-24 5 Physiotherapeutic management 25-36 6 Patient and family education Do’s and don'ts 37-40 7 References 41 8 Questions 42

5. GENERAL OBJECTIVES OF THE SYLLABUS At the end of the session student should be able to understand - Various assessment skills used to evaluate post mastectomy status. Various measures of physiotherapeutic management skills used for post radical mastectomy. The points for Patient/family education regarding do’s and don’ts.

6. Learning objectives Sr.no Learning objectives domain level criteria 1 Explain clinical assessment methods for physiotherapy in post mastectomy cases. Cognitive & Psychomotor Must know All 2 Explain therapeutic methods used for post mastectomy management. Cognitive & Psychomotor Must know All 3 Explain do’s and don’s followed by radical mastectomy. Cognitive & Psychomotor Must know All

7. Chapter Content Sr. No. Topic Slide No 1 Introduction and Types of mastectomy 8-17 2 Problem list 18-19 3 Physiotherapeutic assessment of post radical mastectomy status. 20-24 4 Physiotherapeutic management 25-36 5 Patient and family education Do’s and don'ts 37-40 6 References 41 7 Questions 42

8. INTRODUCTION Mastectomy is the surgical removal of breast. Indications- Carcinoma of breast Surgery is presently the most common treatment for breast cancer.

9. TYPES OF MASTECTOMY Simple or total mastectomy Partial or segmental mastectomy Radical mastectomy Modified radical mastectomy Extended radical mastectomy Super radical mastectomy

10. Simple Or Total Mastectomy Removal of the breast, with its skin and nipple, but no lymph nodes. Greater cosmetic disadvantage Needs skin grafting

11. Partial Or Segmental Mastectomy Removal of a portion of breast tissue and A margin of normal breast tissue.

12. Radical Mastectomy Removal of: entire breast, nipple /areolar region , pectoralis Major & minor muscles clavipectoral fascia & axillary lymph nodes

13. Radical Mastectomy Preserved structures: Axillary vein Nerve to lattissimus dorsi Nerve to serratus anterior

14. Modified Radical Mastectomy Removal of entire breast, nipple/ areolar region, axillary lymph nodes. Pectoralis muscle remains intact

15. Extended Radical Mastectomy Done to remove tumors involving internal mammary lymph nodes. Tumors involving outer 21% and inner 43% quadrant.

16. Super Radical Mastectomy Removal of : Ipsilateral half of sternum Adjacent Portion of 2 nd to 5 th ribs to sternum Internal mammary lymph nodes, mediastinal lymph nodes, supraclavicular lymph nodes & axillary lymph nodes. Adjcent pleura

17. PROBLEM LIST Postoperative incisional pain Lymphoedema Postoperative pulmonary complications Restricted mobility of upper limb

18. Contd… Weakness & restricted functional use of upper extremity Postural deformities Reduced exercise tolerence Psychological considerations

19. POST OPERATIVE ASSESSMENT Inspection Palpation Auscultation

20. INSPECTION Suture site Extent of suture Healthy/ unhealthy: Discharge, redness Drain: present/ not present lymphoedema Chest wall movements Breathing pattern Use of acc. muscles

21. PALPATION No. of sutures Length of suture line Local temperature Tenderness at suture site Mobility of scar (after suture removal) Posture assessment Girth measurement of Upper Extremity Range of Motion of Upper Extremity Strength assessment of UE

22. AUSCULTATION Breath sounds Foreign sounds

23. OTHER ASSESSMENT… Functional capacity assessment Functional activities / health related quality of life.

24. PHYSIOTHERAPY MANAGEMENT Preoperative phase Post- operative phase

25. PRE OPERATIVE MANAGEMENT Teach the patient aspects of self management: Deep breathing, Coughing, Positioning of upper extremity so patient is familiar with it postoperatively.

26. POSTOPERATIVE MANAGEMENT GOALS Patient education Pain Relief Prevent or minimize postoperative lymphoedema Prevent postoperative pulmonary & circulatory complications

27. CONTD… Prevent postural deformities Prevent muscle tension & guarding in cervical musculature Prevent restricted mobility of UE Regain strength & functional use of involved UE Improve exercise tolerance & reduce fatigue

28. MANAGEMENT 1.Patient’s Education 2.Pain Relief : Cryotherapy TENS

29. 3 . Prevention of lymphoedema Elevation of involved upper extremity. on pillows about 30 deg Bandaging-Elastic bandage ROM exercises

30. LYMPHOEDEMA OF PATIENT WITH RADICAL MASTECOMY

31. IF LYMPHOEDEMA DEVELOPES ???? Elevation Manual lymphatic drainage Compression: Low stretch bandages or custom fitted garments Skin care**** Lymphoedema exercises

32. Lymphoedema exercises: Active Circumduction of arm Exercises on a foam roll (axillary lymph nodes) Bilateral hand press(isometric pectoral contraction) Unilateral arm exercises with arm elevated Overhead wall press ups Wrist & finger exercises

33. 4. Upper limb mobility exercise to prevent restricted mobility. Active assisted exercises for shoulder, elbow and wrist. Progress to active exercises. Then start with Low intensity isometric exercises of shoulder Progress to Resistance exercises with light handheld weight Shoulder ROM-not more than 90 deg until removal of drains

34. 5 . Postural correction exercises: Chin tucked in Pectoral stretching Scapula retractor strengthening exercises. Encourage the patient to maintain erect posture during activities.

35. 6. To improve exercise tolerance Graded, low intensity aerobic exercises such as walking and cycling

36. DO'S & DONT’S Before exercising actively, be sure that the surgical wounds are healing.  Do try to start moving the affected arm as soon as possible, do these movements slowly and gently Do practice deep breathing and relaxation techniques  

37. Contd… Do Keep arm elevated after surgery to prevent swelling. Use two pillows to support arm when lying down or sitting. After surgery, try to walk around (indoors) for a few minutes 2 - 3 times daily.  Avoid lifting anything over 2-3 pounds, particularly with the involved arm

38. Don’t let mastectomy arm hang down, especially when holding or carrying objects.  Don’t move arm quickly, or with jerking, pulling motions. Learn to move slowly and smoothly, especially when changing positions, lifting bags, opening doors, etc.  Don’t Wear shoulder bags on involved arm. The pressure of the strap on the shoulder can cause lymphedema .

39. Don’t Continue an exercise upon persistent pain & unusual fatigue. Rest for a moment, breathe, relax, and then continue slowly and carefully. If fatigue persists, stop exercising.  

40. REFERENCES Carolyn Kisner and Colby. Therapeutic Exercise. Foundation and techniques. Seventh edition. Chapter 26.P(1027-1035) Cash textbook of general medical and surgical conditions for physiotherapists. Second edition. Chapter P(103-105)

41. QUESTIONS Explain in detail the physiotherapeutic assessment and management of post operative radical mastectomy. Enlist the types of mastectomy.

42. Thank you…