Shoulder dysfunction related to the lung resection area in the immediate postoperative period after thoracotomy

  • Gastaldi A
  • Miranda A
  • Santos B
  • et al.
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Abstract

Background: Shoulder mobility can become restricted after thoracotomy, mainly due to intense pain, resulting in functional disability of patients who undergo lung resection. Purpose: This study aims to investigate the mobility, pain and disability of the shoulders after different pulmonary surgical procedures. Methods: Participants: 38 patients who underwent lung surgery via thoracotomy (mean age = 57 years). Data measurement: In the preoperative period and first and second days of the postoperative period, all patients were assessed for: range of motion of shoulder flexion and abduction; pain intensity by visual analog scale; and application of the Shoulder Pain and Disability Index (SPADI) questionnaire for evaluation of shoulder function. Data were analyzed by comparing the values obtained in the three days of evaluation, and analyzed in subgroups according to the resection area (biopsy/lumpectomy, lung segmentectomy and lobectomy), using analysis of variance and the Student's t-test, adopting a significance level of 5%. Results: There was a decrease of flexion (153±16° to 98±23°), abduction (151±20° to 126±38°) and increased SPADI (2.4 to 44.3) in the shoulder ipsilateral to surgery from the preoperative to the first postoperative day (p < 0.05). There was a greater loss of ipsilateral flexion and abduction in the lobectomy subgroup (p < 0.05), and decreased abduction and flexion of the contralateral shoulder in the lung segmentectomy subgroup (p < 0.05). Conclusion(s): There is bilateral limitation of range of motion of shoulder elevation, with greater impairment of the ipsilateral shoulder, and more impairment in larger resections. Implications: The development of a program of bilateral exercises for the upper limbs in order to achieve reduction of shoulder dysfunction in the immediate postoperative period, especially in patients undergoing procedures with larger resections, is recommended.

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Gastaldi, A., Miranda, A., Santos, B., Oliveira, A., Abrao, J., Cipriano, F., & Souza, H. (2015). Shoulder dysfunction related to the lung resection area in the immediate postoperative period after thoracotomy. Physiotherapy, 101, e445. https://doi.org/10.1016/j.physio.2015.03.3226

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