Download to read offline
More Related Content
Similar to PHYSIOTHERAPEUTIC MANAGEMENT POST RADICAL MASTECTOMY.pptx
PHYSIOTHERAPEUTIC MANAGEMENT POST RADICAL MASTECTOMY.pptx
- 1. DATTA MEGHE COLLEGEOF PHYSIOTHERAPY. DEPARTMENT OF CARDIOPULMONARY SCIENCES
- 2. PHYSIOTHERAPEUTIC MANAGEMENT POST- RADICALMASTECTOMY. DR. SACHIN CHAUDHARY MPT (Cardio-Respi. Physiotherapy) PROFESSOR & HEAD DATTA MEGHE COLLEGE OF PHYSIOTHERAPY NEHA INGALE CHAUDHARY MPT (Neuro) PROFESSOR & HEAD DATTA MEGHE COLLEGE OF PHYSIOTHERAPY
- 3. PREFACE This PPTis 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. TopicSlide 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 OFTHE 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 Learningobjectives 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 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 isthe 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 TotalMastectomy • Removal of the breast, with its skin and nipple, but no lymph nodes. • Greater cosmetic disadvantage • Needs skin grafting
- 11. Partial Or SegmentalMastectomy • 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 Removalof • entire breast, • nipple/ areolar region, • axillary lymph nodes. Pectoralis muscle remains intact
- 16. Extended Radical Mastectomy •Done to remove tumors involving internal mammary lymph nodes. • Tumors involving outer 21% and inner 43% quadrant.
- 17. Super Radical Mastectomy Removalof : • Ipsilateral half of sternum • Adjacent Portion of 2nd to 5th ribs to sternum • Internal mammary lymph nodes, mediastinal lymph nodes, supraclavicular lymph nodes & axillary lymph nodes. • Adjcent pleura
- 18. PROBLEM LIST • Postoperativeincisional pain • Lymphoedema • Postoperative pulmonary complications • Restricted mobility of upper limb
- 19. Contd… • Weakness &restricted functional use of upper extremity • Postural deformities • Reduced exercise tolerence • Psychological considerations
- 20. POST OPERATIVE ASSESSMENT •Inspection • Palpation • Auscultation
- 21. INSPECTION • Suture site •Extent of suture • Healthy/ unhealthy: Discharge, redness • Drain: present/ not present • lymphoedema • Chest wall movements • Breathing pattern • Use of acc. muscles
- 22. PALPATION No. ofsutures 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
- 23. AUSCULTATION • Breath sounds •Foreign sounds
- 24. OTHER ASSESSMENT… • Functionalcapacity assessment • Functional activities / health related quality of life.
- 25. PHYSIOTHERAPY MANAGEMENT • Preoperativephase • Post- operative phase
- 26. PRE OPERATIVE MANAGEMENT Teachthe patient aspects of self management: • Deep breathing, • Coughing, • Positioning of upper extremity so patient is familiar with it postoperatively.
- 27. POSTOPERATIVE MANAGEMENT GOALS • Patient education •Pain Relief • Prevent or minimize postoperative lymphoedema • Prevent postoperative pulmonary & circulatory complications
- 28. CONTD… • Prevent posturaldeformities • Prevent muscle tension & guarding in cervical musculature • Prevent restricted mobility of UE • Regain strength & functional use of involved UE • Improve exercise tolerance & reduce fatigue
- 29. MANAGEMENT 1.Patient’s Education 2.Pain Relief: • Cryotherapy • TENS
- 30. 3. Prevention oflymphoedema • Elevation of involved upper extremity. on pillows about 30 deg • Bandaging-Elastic bandage • ROM exercises
- 31. LYMPHOEDEMA OF PATIENTWITH RADICAL MASTECOMY
- 32. IF LYMPHOEDEMA DEVELOPES???? • Elevation • Manual lymphatic drainage • Compression: Low stretch bandages or custom fitted garments • Skin care**** • Lymphoedema exercises
- 33. Lymphoedema exercises: • ActiveCircumduction 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
- 34. 4. Upper limbmobility 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
- 35. 5. Postural correctionexercises: • Chin tucked in • Pectoral stretching • Scapula retractor strengthening exercises. • Encourage the patient to maintain erect posture during activities.
- 36. 6. To improveexercise tolerance • Graded, low intensity aerobic exercises such as walking and cycling
- 37. 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
- 38. Contd… • Do Keeparm 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
- 39. • Don’t letmastectomy 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.
- 40. • Don’t Continuean exercise upon persistent pain & unusual fatigue. • Rest for a moment, breathe, relax, and then continue slowly and carefully. If fatigue persists, stop exercising.
- 41. REFERENCES • Carolyn Kisnerand 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)
- 42. QUESTIONS • Explain indetail the physiotherapeutic assessment and management of post operative radical mastectomy. • Enlist the types of mastectomy.
Editor's Notes
- #30 Cryotherapy is useful when the condition is acute. It reduces inflammation by decreasing blood flow to the localised area, decreases inflammatory response & minimizes haemorrhage. Its is observed that ncv decreases due to cooling . Hence muscle responsiveness to stretch decreases, Thus reduces muscle gurding and promotes pain relief. High freq short duration tens(conventional) is beneficial. It produces mild to mod. Paresthesia without msl contraction.the onset of relief is fast but its effect is short lived (few hours).