Myofascial Pain Syndrome in Patients With Breast Cancer-related Lymphedema

"Major criteria:~1. The patient's complaint of regional pain~2. Referred pain and sensory change in the specific area of the muscle by palpation of the trigger point~3. Presence of palpable taut band~4. Presence of palpable and tender points along the length of the taut band~5. Restriction of ROM in the area of the affected muscle~Minor criteria:~1. Pain/sensory change with pressure palpation of the trigger point~2. Local twitch response with palpation/injection of the trigger point in the taut band~3. Reduction of pain by inactivation (injection or stretching of the muscle) of the trigger point 5 major and at least 1 minor criteria are required for clinical diagnosis"

Trigger points in trapezius, infraspinatus, latissimus dorsi, pectoralis major, serratus anterior muscles will be detected bilaterally by physical examination. Algometer (Wagner Force Dial FDK 20) will be used for pain pressure threshold measurement of detected trigger points. Then, the distribution of the trigger points, their frequency and threshold values according to the algometer will be compared between the individual affected-insured extremities and between the groups.

The purpose of this test is to test the maximum isometric contraction strength of the hand and forearm muscles. A hand grip dynamometer (Jamar) will be used for the test. While the patient is sitting in the chair, the elbows will be close to the body and at 90 degree flexion, the wrist will be in a neutral position. The patient will be asked to grasp the dynamometer and squeeze it as hard as she can, and the average of 3 measurements made with an interval of 5 minutes. The test will be repeated for both upper extremities separately.

Shoulder pain, feeling of tension and heaviness on the affected arm will be evaluated separately by numerical scale.

The quick DASH questionnaire which has proven reliable and valid in breast cancer and lymphedema patients in Turkish population, will be used to evaluate the quality of life related to upper extremity function.

Lymphedema Quality of Life Scale-Arm Turkish form will be used. The lymphedema-specific quality of life scale was developed specifically for the upper extremity and its reliability and validity were proven in Turkish population.

Goniometric measurements will be made for both upper extremities, and the average of 3 consecutive measurements will be taken.