Disability of Arm, Shoulder and Hand Using Dash Scoring System after Axillary Dissection for Breast Cancer at Tertiary Care Hospital, Karachi
DOI:
https://doi.org/10.70749/ijbr.v3i7.3026Keywords:
Breast Cancer, Axillary Dissection, DASH Score, Functional Disability, Rehabilitation, Cancer Stage.Abstract
Background: Many women experience upper limb dysfunction after axillary dissection for breast cancer. However, the extent and contributing factors remain under examined in local clinical settings. We aimed to assess the level of arm, shoulder, and hand disability using the DASH (Disabilities of the Arm, Shoulder and Hand) score. We will also identify patient and surgical factors associated with increased impairment. Methods: We carried out a cross-sectional study involving 131 women treated with axillary dissection at a tertiary care hospital in Karachi. We recorded demographic data, cancer stage, surgical duration, and employment status. We then categorized DASH scores into mild, moderate, or severe disability and used chi-square tests to explore associations between disability level and clinical variables. Results: Most patients reported moderate (38.9%) or severe (37.4%) disability. Those who underwent shorter surgeries (≤ 2 hours) were more likely to report mild disability (p = 0.01), although moderate disability was also common in this group (p = 0.02). Patients with Stage III breast cancer showed significantly higher rates of severe disability (p = 0.03). We found no significant links between disability and age or employment status, though we observed non-significant trends in both. Conclusion: Upper limb disability remains a frequent outcome after axillary surgery, particularly among women with advanced-stage disease. Shorter operative times may help limit long-term impairment. Routine use of tools like the DASH score and early referral to rehabilitation services may improve functional outcomes and support recovery in this high-risk population
Downloads
References
1. Kootstra, J. J., Dijkstra, P. U., Rietman, H., De Vries, J., Baas, P., Geertzen, J. H., Hoekstra, H. J., & Hoekstra-Weebers, J. E. (2013). A longitudinal study of shoulder and arm morbidity in breast cancer survivors 7 years after Sentinel lymph node biopsy or axillary lymph node dissection. Breast Cancer Research and Treatment, 139(1), 125-134.
https://doi.org/10.1007/s10549-013-2509-y
2. Shamley, D., Lascurain‐Aguirrebeña, I., & Oskrochi, R. (2013). Clinical anatomy of the shoulder after treatment for breast cancer. Clinical Anatomy, 27(3), 467-477.
https://doi.org/10.1002/ca.22267
3. Harrington, S., Padua, D., Battaglini, C., Michener, L. A., Giuliani, C., Myers, J., & Groff, D. (2011). Comparison of shoulder flexibility, strength, and function between breast cancer survivors and healthy participants. Journal of Cancer Survivorship, 5(2), 167-174.
https://doi.org/10.1007/s11764-010-0168-0
4. Lee, T. S., Kilbreath, S. L., Refshauge, K. M., Herbert, R. D., & Beith, J. M. (2007). Prognosis of the upper limb following surgery and radiation for breast cancer. Breast Cancer Research and Treatment, 110(1), 19-37.
https://doi.org/10.1007/s10549-007-9710-9
5. Hidding, J. T., Beurskens, C. H., Van der Wees, P. J., Van Laarhoven, H. W., & Nijhuis-van der Sanden, M. W. (2014). Treatment related impairments in arm and shoulder in patients with breast cancer: A systematic review. PLoS ONE, 9(5), e96748.
https://doi.org/10.1371/journal.pone.0096748
6. Nesvold, I., Reinertsen, K. V., Fosså, S. D., & Dahl, A. A. (2010). The relation between arm/shoulder problems and quality of life in breast cancer survivors: A cross-sectional and longitudinal study. Journal of Cancer Survivorship, 5(1), 62-72.
https://doi.org/10.1007/s11764-010-0156-4
7. O’Toole, J. A., Ferguson, C. M., Swaroop, M. N., Horick, N., Skolny, M. N., Brunelle, C. L., Miller, C. L., Jammallo, L. S., Specht, M. C., & Taghian, A. G. (2015). The impact of breast cancer-related lymphedema on the ability to perform upper extremity activities of daily living. Breast Cancer Research and Treatment, 150(2), 381-388.
https://doi.org/10.1007/s10549-015-3325-3
8. Boquiren, V. M., Hack, T. F., Thomas, R. L., Towers, A., Kwan, W. B., Tilley, A., Quinlan, E., & Miedema, B. (2016). A longitudinal analysis of chronic arm morbidity following breast cancer surgery. Breast Cancer Research and Treatment, 157(3), 413-425.
https://doi.org/10.1007/s10549-016-3834-8
9. Beaton, D. E., Boers, M., & Wells, G. A. (2002). Many faces of the minimal clinically important difference (MCID): A literature review and directions for future research. Current Opinion in Rheumatology, 14(2), 109-114.
https://doi.org/10.1097/00002281-200203000-00006
10. Ahmed, R. L., Prizment, A., Lazovich, D., Schmitz, K. H., & Folsom, A. R. (2008). Lymphedema and quality of life in breast cancer survivors: The Iowa women's health study. Journal of Clinical Oncology, 26(35), 5689-5696.
https://doi.org/10.1200/jco.2008.16.4731
11. Koehler, L. A., Blaes, A. H., Haddad, T. C., Hunter, D. W., Hirsch, A. T., & Ludewig, P. M. (2015). Movement, function, pain, and postoperative edema in axillary web syndrome. Physical Therapy, 95(10), 1345-1353.
https://doi.org/10.2522/ptj.20140377
12. Koehler, L. A., Hunter, D. W., Blaes, A. H., & Haddad, T. C. (2018). Function, shoulder motion, pain, and lymphedema in breast cancer with and without axillary web syndrome: An 18-Month follow-up. Physical Therapy, 98(6), 518-527.
https://doi.org/10.1093/ptj/pzy010
13. Eckhoff, L., Knoop, A., Jensen, M., & Ewertz, M. (2015). Persistence of docetaxel-induced neuropathy and impact on quality of life among breast cancer survivors. European Journal of Cancer, 51(3), 292-300.
https://doi.org/10.1016/j.ejca.2014.11.024
14. Riaz, S., Soomro, S., Manzoor, S., Kumar, D., & Mohammad, D. (2015). Assessment of disability of arm, shoulder and hand using DASH scoring system after axillary dissection for breast cancer. Pak. J. Surg, 31, 111-114.
15. Mbaabu, K., & Wasike, R. (2020). Upper arm disability after axillary surgery for early breast cancer. Annals of African Surgery, 17(3), 99-102.
https://doi.org/10.4314/aas.v17i3.2
16. Mizuta, M., Okumura, M., Inoue, J., Ueda, Y., Kondo, S., Miki, M., Kunihisa, T., Ono, R., Sakai, Y., & Akisue, T. (2025). Association between preoperative grip strength and postoperative upper extremity impairments in patients with breast cancer: A retrospective cohort study. Breast Cancer, 32(4), 750-756.
https://doi.org/10.1007/s12282-025-01699-2
17. Gosselink, R., Rouffaer, L., Vanhelden, P., Piot, W., Troosters, T., & Christiaens, M. (2003). Recovery of upper limb function after axillary dissection. Journal of Surgical Oncology, 83(4), 204-211.
https://doi.org/10.1002/jso.10271
18. Hayes, S. C., Johansson, K., Stout, N. L., Prosnitz, R., Armer, J. M., Gabram, S., & Schmitz, K. H. (2012). Upper‐body morbidity after breast cancer. Cancer, 118(S8), 2237-2249.
https://doi.org/10.1002/cncr.27467
19. Engel, J., Kerr, J., Schlesinger-raab, A., Eckel, R., Sauer, H., & Hölzel, D. (2003). Predictors of quality of life of breast cancer patients. Acta Oncologica, 42(7), 710-718.
https://doi.org/10.1080/02841860310017658
20. Davies, C., Brockopp, D., & Moe, K. (2013). Internal consistency of the disability of arm, shoulder and hand (DASH) outcome measure in assessing functional status among breast cancer survivors. Rehabilitation Oncology, 31(4), 6-12.
https://doi.org/10.1097/01893697-201331040-00003
21. Smoot, B., Wong, J., Cooper, B., Wanek, L., Topp, K., Byl, N., & Dodd, M. (2010). Upper extremity impairments in women with or without lymphedema following breast cancer treatment. Journal of Cancer Survivorship, 4(2), 167-178.
https://doi.org/10.1007/s11764-010-0118-x
22. McNeely, M. L., Binkley, J. M., Pusic, A. L., Campbell, K. L., Gabram, S., & Soballe, P. W. (2012). A prospective model of care for breast cancer rehabilitation: Postoperative and postreconstructive issues. Cancer, 118(S8), 2226-2236.
https://doi.org/10.1002/cncr.27468
23. Andersen, K. G., & Kehlet, H. (2013). Persistent pain after breast cancer treatment. Pain in Women, 186-197.
https://doi.org/10.1093/med/9780199796410.003.0013
24. Lacomba, M. T., Yuste Sanchez, M. J., Goni, A. Z., Merino, D. P., Del Moral, O. M., Tellez, E. C., & Mogollon, E. M. (2010). Effectiveness of early physiotherapy to prevent lymphoedema after surgery for breast cancer: Randomised, single blinded, clinical trial. BMJ, 340(jan12 1), b5396-b5396.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
