shoulder mobility
I'm wondering if any of you have shoulder mobility issues when your lymphedema flares? To summarize my reason for asking, I had a lymphedema therapist tell me, very strongly, that my inability to raise my arm above shoulder height could not be caused by lymphedema - that it "didn't do that." I'm now feeling like some sort of paranoid hypochondriac. This is all really bothering me far more than it should, but I am upset.
Long story in short form: In 1987, I was hit by a car and had a badly broken shoulder. The doctors couldn't do much for it - it's crooked and I lost almost 20% range of motion. It's actually been surprisingly good all these years. I make sure to strengthen and stretch it - I am a certified personal trainer and fitness instructor. So, I've done pretty well with it and really didn't have any pain. Then in June of 2011, I was diagnosed with Stage 1 breast cancer. I had a lumpectomy, sentential node dissection and radiation. After surgery I developed a large cord and a seroma, which then developed cellulitus. I only lost one lymph node. In the spring of 2012, my shoulder began to stiffen up again and I really felt as if there was fluid in it. My breast surgeon saw pitting edema in the breast tissue underneath my arm. She sent me to the lymphedema therapist, who found lots of lymph in my breast and the back of my upper arm - but mostly my breast. The MLD really helped. I was fitted with a sleeve, a glove (I use this when I lift weights or do any heavy exercise), a gauntlet, a Solaris Tribute night sleeve, swell spots and a FlexiTouch.
While we were waiting for the garments, I began to have a tingling in my forearm and my arm began to feel heavy. I did have some increased volume in my left arm, which went down during the weeks of MLD. My shoulder mobility also returned to normal for me. I could again brush my hair and lift a weight over my head.
That summer, my arm would swell on humid days. I've worn the garments faithfully even since. Last winter, I broke my wrist. The cast had to be removed early because of swelling - it was super tight after a few weeks. My arm actually went back down once I started back with the FlexiTouch and wearing garments again. The Solaris Tribute really works well for me.
This summer, my arm was awful. It's not snapping back when the humidity goes down. I do well with exercise - but I can't sit for long. It really feels awful. I spent as much time as I could, while still doing my job, with the arm wrapped - which it really likes. This fall, I'm getting ridges of lymph in my wrist and elbow. They go down at night in the machine and the night sleeve. This has all been rather scary. My lymphedema is still mild - but it's really interfering with my life - it seems to be worsening. My medical oncologist, suggested I go back for my therapy.
I went for the evaluation. The therapist found my left arm to be smaller than my right arm - but remember, I broke my wrist 6 months before. My strength is good - but still not 100% where it was. She thinks my problems stem from the earlier trauma to my shoulder and the loss of the node put it over the edge. I have always suspected this to be the case. My swelling is worse on my upper arm - at the back of my shoulder just above the sleeve. She suggested being even more aggressive - wearing the glove more often and wrapping more often - when possible. And the therapists would work on my shoulder especially.
When I went for my first treatment, I had the 3rd therapist at the hospital (there are 3 who do lymphedema). She said that since my arm was smaller - I really should try and go without the sleeve when I wasn't actively exercising. She said the sleeve I have fits me perfectly - but that maybe the silicone band on it was causing the swelling above it. I didn't have this swelling last year except in extreme humidity and we've always ordered my sleeves with the silicone bands. She asked if I really did have lymph in my breast in 2012 - or was it maybe just fluid from the radiation? She truly made me feel as if I don't really have lymphedema but that the sleeve is causing all of these problems. She did work on my shoulder - finding some really tightness and odd spots in it - and in my elbow.
The arm felt much better all week, but I was feeling emotionally unhappy. Last Monday, my sleeve was really bothering me around my elbow at the end of the day as it sometimes does, so I decided to humor her and take it off. Hey - maybe there really is nothing wrong with me? I didn't use the machine, nor did I wear the night sleeve. I felt pretty good in the morning - no pain or tingling in the arm. But - I found I couldn't raise my arm above shoulder height. I put on my sleeve and taught class - not well as my arm was not moving well at all. I took the sleeve off again after class to complete the experiment. Then saw her for the appointment in the afternoon where she declared my arm issue couldn't be lymph related. What else could it be from? I hadn't done anything to cause such a problem. She again worked on the shoulder and did MLD - which made my arm much better. That evening I used my machine and wore my night sleeve. My arm was back to normal the next morning.
My question really is could this all be caused by a well-fitting sleeve? And can lymphedema cause a problem in the shoulder like this? My arm does look good - except at the very top where you wouldn't measure. I just can't imagine this is all some craziness in my head - that's not exactly like me - and it's not as if I enjoy having lymphedema. It's been rather frightening really - I'm used to being super healthy. I can't find a lot of information on lymphedema specifically causing shoulder mobility issues though.
Comments
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Not sure what you have going on with you but I wear a sleeve that comes over the shoulder and a strap holds it up under my non affected side breast. I do notice if I wear a banded sleeve opposed to the over the shoulder sleeve my top of my arm just gets a bit crankier. I have mild LE but I do notice a difference. The sleeve that I like is Juzo over the shoulder from brightlifedirect. Great return policy I may add and reasonable -
I have very mild LE both truncal and and upper arm. As it has gradually gotten more active, my shoulder now hurts with flares. I too have a regular sleeve and wonder if one that comes over the shoulder would be more effective. With LE in both trunk and arm, why would the shoulder not be affected? Seems logical to me. It's in between the two LE areas. -
I'd be checking the credentials of that last therapist! When you returned to your LE treatment regimen, your symptoms improved...doesn't take a genius to realize that excess lymph was causing the problem!
Your shoulder injuries from the car accident no doubt left you with lots of internal scar tissue, and lymph does not travel well through scars. It's not unusual for people to develop LE after trauma from an accident. You may have had latent LE (stage 0...no visible swelling but up to 30% more lymph in the area) without realizing it, and then the sentinel node biopsy was the final straw. I have not read of anyone commenting on shoulder mobility problems from LE, but over the shoulder is a lymph pathway from the arm, and I know from my own experience that I can get a very debilitating heaviness and ache in my upper arm when the LE flares, so it would not surprise me to hear that reduced mobility could also develop.
In addition to the ideas for over-the-shoulder sleeves, you might try a really tight compression T shirt with your existing sleeve. If you're tiny, it will be hard to find a size that's snug enough to give serious compression to the shoulder, but if you can compress that whole area, it might help. I use a men's size small UnderArmour, in dark colors (have found that the gray version is not as compressive). The women's UA shirts have cap sleeves that are too short and cut into the axilla, but the men's sleeves seem just right. It's hard to find, but they also make boys' sizes in the compression fit, if you need to find something really small.
I also have some shapewear that covers the shoulder, and that might help you to get some compression on your shoulder, too. The catalog where I have found some of these is herroom.com. I've had to shorten the sleeve to avoid long overlap with my compression sleeve, but generally they work for me and the necklines are more wardrobe friendly than the UA shirts.
Keep us posted on what you figure out. And by the way, here's a shout-out to you and all the other certified trainers in the world...what a difference it makes to have an expert set up and supervise a weight and exercise program. My trainer is one of my lifetime personal heroes. Thanks for doing what you do! And you've got to find a way to tame the LE beast so you can preempt any occupational roadblocks! -
Thank you all. I'm feeling much better about it all. I don't know exactly why - but I am convinced my shoulder mobility problem is from lymph. It's totally back to normal - and feels even better tonight after going for more therapy today. I think some of it may be a tight pec muscle from radiation - but still, it's when the lymph is bad that I have trouble with it.
I do think the over-the-shoulder sleeve might help. I may try one. I did try a small boy's compression shirt when I was originally seeing the first therapist to try and combat the lymph she felt in my shoulder and upper arm. It just didn't hit my arm pit enough - mostly it squished my chest, but not my arm as I am small.
Anyway - I'm not going to attempt going without the sleeve and night sleeve again. It's really in the summer when I wear short sleeves that I'd like to anyway - and then it's really not a good idea as that's a bad time of year with all the humidity.
And thanks, Carol - I do love being a trainer. It's really rewarding to help people. -
Trainer, my LE is very mild and is usually under control even without wearing a sleeve. Recently my shoulder starting aching and acting up. I did exercises and stretches, nothing doing. Then on a lark, I wore my sleeve and gauntlet for a few days and the shoulder trouble disappeared. Also do try going heavy on the anti-inflammatory foods for a week or so. -
Trainer, I second Carol on not supporting the most recent LE therapist--I have a smaller arm on my LE side, and I broke my scaphoid on that side, two years ago, and there have been a few LE therapists who just don't get it, and have told me that 1) I don't have LE or 2) I can back off treatment due to the small arm.
LE is not defined by volume increases: there is no actual definition, and much of the problem is inflammation, and just decreasing volume doesn't mean you're cured or you don't have LE. It's right here on bc.org, from Andrea Cheville:
http://www.breastcancer.org/treatment/lymphedema/evaluation/diagnosis
According to Andrea Cheville, MD, associate professor of physical medicine and rehabilitation at Mayo Clinic, it’s important to look at the whole picture: not just size and volume measurements, but the appearance of the limb or other body part. “There is no one value or standard you can use to say, ‘OK, if you meet that you have lymphedema, and if you don’t, well then you don’t have it,’” says Dr. Cheville. “For example, there may be no size or volume changes in the arm, but you could have subtle hand swelling or pitting on the arm. So it’s important not to be too locked into arm measurements alone, as that can create a false sense of security. You also need to be watching the arm and looking for the loss of what we call ‘anatomic architecture’ — an inability to see the veins and tendons in the arm as clearly, or less pronounced knuckles, or skin that is less wrinkled and therefore looks younger.”
My arm is small because I treat it.
I took a full CLT course, and while I learned a lot, it also made me realize how therapists can be trained and still have a large knowledge defecit: it's 135 hours, but 40 are web based lectures and then you do 10 long days. I was the student from hell--the teacher would say "Lymphatic transport capacity is fixed" and I'd say, "Actually....there are multiple studies to show that the lymphatic pump fatigues". I did the "Actually" thing a lot. I thought my fellow students would hate me, but they actually told me that they felt they learned a lot. I had my trusty iPad and would interupt her constantly.
No one can become expert after 10 days. It's just not possible.
In the past, LANA wouldn't allow a therapist/CLT to take the course until they'd worked in the field for a year, but recently, they dropped that requirement--because so few people are taking the test.
So, you meet a lot of LE therapists who learned a bit, and don't know what they don't know. And they can get dogmatic.
I have had shoulder issues since getting LE (and mine is mostly in my left hand/forearm): 1) I got a classic frozen shoulder on my LE arm after 6 weeks in my thumb spica cast--which had to be bivalved to relieve swelling--I had a miserable day after the second cast, went back once and the cast tech was clueless, and went back a second time and got a great cast tech who cut channels into it to accomodate swelling. And now, when I was home recovering from my tamoxifen related hyst, I reached behind me and tore something in my right shoulder: I'm currently in PT with a PT who is also LE trained (my personal LE therapist is an LMT) and she thinks I tore my pec, and it's slow going. It's rough, because I don't have a "good" arm currently. And I'm sure the lack of estrogen after the hyst isn't helping.
Back to you: classic LE symptoms include joint dysfunction. You know your body. The LE therapist doesn't know what she doesn't know. Breast LE is very, very common and will tend to improve over time, but her discounting yours is a classic case of denying your reality.
I agree that your prior trauma set you up. Listen to your body and do what works, and if you can, gently educate the LE therapist. -
In my LE arm, I also have a torn rotator cuff that happen during my radiation treatments. This summer when the swelling went up the neck and back of the shoulder, I had major problems with that arm. I couldn't put it behind my back at all. It hurt to raise it. After the two weeks of wrapping I got back most of my limited movement. My shoulder is frozen but not bad. I still can tell when I am really swollen in the shoulder because I start hurting with movement.
I don't think you are crazy but we both might be crazy together!
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I don't care what the LE therapist told you....I am in the same boat. My left shoulder was bummed up a few years back. I deal with LE everyday, but I have "flares" 1-2 per month. When it flares, my mobility is affected & it hurts. My LE is truncal affecting both shoulders & now it seems to be moving into my left leg!
I had a flare up last week, a bad one. And, I can feel it starting back again tonight. I am trying the brushing and hoping that is just moving the fluid around some. So far, nothing much has helped me. -
Thank you all - I do feel so much better knowing that others have these issues too. Not that I'm happy anyone else has this! But yes - I just can't see how my shoulder mobility issue isn't LE related. My shoulder was broken all those years ago and has never been right - they just couldn't do anything with it to make it totally better - but it really hasn't bothered me much in the last 20 years. That's why I wasn't really worried about the node surgery at all.
There really is no other explanation as to why I have so much lost mobility other than the LE. I just don't have much swelling in my arm - it's mostly in the top of the arm and my side if I wear the wrong garment. Thank you Kira for pointing out that you can have an arm be smaller and still have LE. I treat it - so it stays small. That's what I was told to do. That lymph is damaging - so not treating it wasn't smart. So, I've worn the compression and done everything else I was told to do - including the low-salt diet. When I treat it - mostly it's fine and feels good. But not always - and that's the reason I was back in therapy. Because the not feeling good times had become more frequent - despite my doing everything I knew to do.
By the way - the therapy is helping. The MLD and the work on my shoulder have made everything feel much better. I think I'm going to have to find someone to go to every so often for MLD and shoulder work - my insurance will only cover this so many times - but it seems to be something I need in addition to the machine. And working on my shoulder isn't something I can do myself.
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