Last Modified: June 29, 2008
Dear OncoLink "Ask The Experts,"
Having had left mastectomy and lymph node dissection 12 years ago, I understand [that] I will always have a risk of lymphedema in my left arm. After several months of left shoulder pain and decreasing range of motion, an MRI showed some fluid in the bursa and my Orthopedics Doctor diagnosed “impingement syndrome”. He offered a steroid injection, which I have so far declined, due to risk of developing lymphedema.
Do you know of patients who have had a steroid injection to the shoulder area several years post lymph node dissection?
If non-invasive therapies are unsuccessful to reduce shoulder pain and restore range of motion, is a steroid injection a reasonable risk? And if surgery to the shoulder is suggested later, does the risk of infection/lymphedema outweigh the possible benefit of surgery?
Linda McGrath Boyle PT, DPT CLT-LANA, Cancer Rehab Specialist and OncoLink Lymphedema Team Editor, responds:
Shoulder problems (rotator cuff and others) are common in breast cancer survivors. I would not be too hasty with invasive intervention. Begin with conservative treatment by a physical therapist who is knowledgeable in lymphedema and orthopedics. If you need to be connected with services in her area there are clinics listed on the National Lymphedema Network, Klose Training, Norton School (must call and request).
I would suggest that injections are not the first option if you have had a breast cancer with lymph node dissection. I have known patients who have received injections, but this is not without risk. If you refer to the National Lymphedema Network's website, it is suggested to avoid injections in the at-risk area.
It is your choice as to whether or not you would like to take the risk of an injection. Conservative physical therapy by a qualified individual is often very successful at avoiding injection or surgical intervention. If you have undergone radiation therapy, your tissues may be more fibrotic (firm). It is not unusual for breast cancer survivors to have abnormal movement patterns due to tight tissues and weak muscles in the shoulder/shoulder blade areas.
As for surgical interventions, this is also your choice whether or not to take the risk. The surgery will increase your lymphatic load in the involved area. You will want to discuss your surgeon's experience with performing surgery on persons at risk for lymphedema. You may want to obtain additional medical opinions before undergoing surgery. The NLN has some tips about surgery on an affected limb.