Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Severe Muscle Cramps In The Arm After Breast Cancer Surgery?
Question: My aunt has undergone quadrantectomy + axillary dissection for early stage breast cancer T2N0M0 3 months back. She is at present undergoing chemotheraphy but experiencing a muscle cramp kind of formation in her operated arm. She is doing expercises to avoid lymphedema.
Please see the attached images and advise on whether this can be a symptoms of lymphedema? She has pain when that portion is pressed.
Please see the attached images and advise on whether this can be a symptoms of lymphedema? She has pain when that portion is pressed.
Brief Answer:
Not a classical lymphedema
Detailed Answer:
Hi.
Thanks for your query for your aunt and the photos you have provided.
Noted the history you have put-in and seen the photos you have attached herewith.
C/O experiencing a muscle cramp kind of formation in her arm on the operated side - pain when that portion is pressed / tenderness - doing exercises to avoid lymphedema - wants advise on whether this can be a symptom of lymphedema...
As per the history and the pictures this does not seem to be lymphedema as it is not uniform, skin is wrinkled at many places.
Classical lymphedema is uniform swelling, never painful, does not pit on pressure nor cause any tenderness,
Please provide some additional information for me to assist her better:
Is there any pain in the neck, particularly on the backside, any muscle spasm?
Is she doing the exercises beyond tolerance to avoid lymphedema.
Is the upper limp in hanging position or above the heart level in lying down position?
Any diabetes, blood pressure and its medications?
Does she have swelling at other parts of the body, particularly the lower limbs - legs and foot including the toes?
Any other information that you would like to share further.
Awaiting for your feedback.
Not a classical lymphedema
Detailed Answer:
Hi.
Thanks for your query for your aunt and the photos you have provided.
Noted the history you have put-in and seen the photos you have attached herewith.
C/O experiencing a muscle cramp kind of formation in her arm on the operated side - pain when that portion is pressed / tenderness - doing exercises to avoid lymphedema - wants advise on whether this can be a symptom of lymphedema...
As per the history and the pictures this does not seem to be lymphedema as it is not uniform, skin is wrinkled at many places.
Classical lymphedema is uniform swelling, never painful, does not pit on pressure nor cause any tenderness,
Please provide some additional information for me to assist her better:
Is there any pain in the neck, particularly on the backside, any muscle spasm?
Is she doing the exercises beyond tolerance to avoid lymphedema.
Is the upper limp in hanging position or above the heart level in lying down position?
Any diabetes, blood pressure and its medications?
Does she have swelling at other parts of the body, particularly the lower limbs - legs and foot including the toes?
Any other information that you would like to share further.
Awaiting for your feedback.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor for the detailed response.
Please see my answers below:
She dont have any pain in the neck but complaining pain in the shoulder area, especially the backside of shoulder area.
She is doing exercise morning and eveing everyday. May be putting more effort to complete all excersises to get relief from pain.
I am not very sure on your question on upper limp. But have taken a picture of her both hands just to give a better idea. I dont see much difference in the structure of both hands except the swelling I mentioned in her operated right hand.
She is not diabetic and dont have blood pressure.
No swelling in other part of the body.
As mentioned earlier, the swelling formation is painfull when pressured and she is also complaining of pain when moving the hands. Bacially her pain is not subsiding after the operation.
Since she had radiating pain, we had shown her to neurlogist as well and based on his suggestion she is taking PENTANERVE NT 400/10 tablet once daily at bed time.
I also feel that complete axillary dissection should have been avoided in her case as she had negative lymph nodes. Operation happened in a hurry after knowing about breast cancer and the surgeon didnt advise us on the sentinal node biopsy. Are we practising the sentinal node biopsy in India?
Basically she is complaining too much pain in the axillary dissection area everyday and the surgeon, medical oncologist and neurologist are saying it takes sometime to heal. But at present her quality of life is not good because of the pain in arm + chemo side effects.
Please see my answers below:
She dont have any pain in the neck but complaining pain in the shoulder area, especially the backside of shoulder area.
She is doing exercise morning and eveing everyday. May be putting more effort to complete all excersises to get relief from pain.
I am not very sure on your question on upper limp. But have taken a picture of her both hands just to give a better idea. I dont see much difference in the structure of both hands except the swelling I mentioned in her operated right hand.
She is not diabetic and dont have blood pressure.
No swelling in other part of the body.
As mentioned earlier, the swelling formation is painfull when pressured and she is also complaining of pain when moving the hands. Bacially her pain is not subsiding after the operation.
Since she had radiating pain, we had shown her to neurlogist as well and based on his suggestion she is taking PENTANERVE NT 400/10 tablet once daily at bed time.
I also feel that complete axillary dissection should have been avoided in her case as she had negative lymph nodes. Operation happened in a hurry after knowing about breast cancer and the surgeon didnt advise us on the sentinal node biopsy. Are we practising the sentinal node biopsy in India?
Basically she is complaining too much pain in the axillary dissection area everyday and the surgeon, medical oncologist and neurologist are saying it takes sometime to heal. But at present her quality of life is not good because of the pain in arm + chemo side effects.
Brief Answer:
as explained in details.
Detailed Answer:
Thanks for your feedback, noted well.
Shoulder pain: - backside of shoulder - Cause has to be found out.
Radiating pain: means the origin may be somewhere else like cervical spine, just a possibility we have to explore.
Pentanerve NT is Gabapentin 400 MG+Nortriptyline 10 MG, very good controller of pain of nerve origin, may need increase like twice a day - obviously after consulting the Neurologist.
Pain in the axillary area: It takes time as you have already been told. With cancer patients there is a a psychological overlay as a cause of intense pain. You can imagin what an Aunt must be going through the psychological turmoil, hence many a times a Psychiatrist/ Counselling and/or medications helps; Pentanerve NT helps in this regards too.
I would advise you the following in such a situation:
MRI of the neck for cervical spine and MRI of the shoulder area to find or rule out the cause of pain should help.
Cancer: The name is sufficient to frighten anyone.
The Surgeon must have a valid reason for operating the axilla too as the lump is N2 - 3 cm as you have noted and axilla must have palpable large lymph nodes. If the sentinel lymph node comes out to be positive, it takes another anesthesia, another surgery. Clearing the palpable lymph nodes reduces the tumor nodes and we should be happy that they all were negative.
Sentinel node biopsy: your Surgeon can tell you the best.
I hope this answer helps you further, please feel free to ask for further relevant queries if you feel that there is a gap of communication.
as explained in details.
Detailed Answer:
Thanks for your feedback, noted well.
Shoulder pain: - backside of shoulder - Cause has to be found out.
Radiating pain: means the origin may be somewhere else like cervical spine, just a possibility we have to explore.
Pentanerve NT is Gabapentin 400 MG+Nortriptyline 10 MG, very good controller of pain of nerve origin, may need increase like twice a day - obviously after consulting the Neurologist.
Pain in the axillary area: It takes time as you have already been told. With cancer patients there is a a psychological overlay as a cause of intense pain. You can imagin what an Aunt must be going through the psychological turmoil, hence many a times a Psychiatrist/ Counselling and/or medications helps; Pentanerve NT helps in this regards too.
I would advise you the following in such a situation:
MRI of the neck for cervical spine and MRI of the shoulder area to find or rule out the cause of pain should help.
Cancer: The name is sufficient to frighten anyone.
The Surgeon must have a valid reason for operating the axilla too as the lump is N2 - 3 cm as you have noted and axilla must have palpable large lymph nodes. If the sentinel lymph node comes out to be positive, it takes another anesthesia, another surgery. Clearing the palpable lymph nodes reduces the tumor nodes and we should be happy that they all were negative.
Sentinel node biopsy: your Surgeon can tell you the best.
I hope this answer helps you further, please feel free to ask for further relevant queries if you feel that there is a gap of communication.
Note: For further inquiries on surgery procedure and its risks or complications book an appointment now
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
