Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection – A randomised controlled trial

Two hundred and thirty women who had undergone surgery for breast cancer were randomised to a prospective study, comparing early (group A) and delayed (group B) shoulder exercise. Preoperatively, group A received instructions and an exercise programme supervised by a physiotherapist, whereas group B received written instructions to use the arm normally but to avoid heavy work. Two weeks after surgery both groups were given identical exercise programmes. Shoulder mobility, hand strength and arm volume were measured preoperatively, 1 month, 6 months and 2 years postoperatively. After 2 years 13.8% of the women had lymphoedema, but there were no significant differences between the groups. Grip strength was slightly decreased during the postoperative period in both groups (n.s.). Postoperatively, all movements in both groups were decreased after 2 weeks and 1 month and shoulder elevation and abduction remained decreased at 2 years. Mobility in group A recovered significantly earlier than in group B.