Document Type : Original Articles


1 Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

2 Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran



Background: Upper extremity (UE) lymphedema, which negatively affects patients' personal and social well-being, is the most common complication after breast cancer treatment. Previous studies have shown the adverse effects of surgical interventions after breast cancer on spine postures and UE disability; however, the relationships between UE volume and postural changes and between UE volume and UE disability in patients with lymphedema have not been studied. Furthermore, some postural changes in the spine like forward head posture has not been assessed in these patients.  Therefore, the aim of this study was to investigate the relationship between the volume of the affected UE with the forward head posture (FHP), kyphosis, shoulder protraction, and UE disability in lymphedema patients.
Methods: In this cross-sectional study, 32 women with unilateral UE lymphedema participated. UE volume and kyphosis were measured by volumetry and a flexible ruler, respectively. Cervical angle was used to assess FHP. For shoulder protraction and FHP calculation, data obtained from markers and photography was analyzed by ImageJ software. The disability of the affected UE was assessed by the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Pearson's correlation test was used to analyze the data.
Results: A significant positive correlation was shown between UE volume and UE disability as well as kyphosis. A significant negative correlation was shown between UE volume and shoulder angle and cervical angle. A significant negative correlation was seen between UE disability and shoulder angle. The relationships between upper limb disability and kyphosis and cervical angles were not significant.
Conclusion: An increase in the affected UE volume because of lymphedema is related to an increase in UE disability, kyphosis angle, forward head posture, and shoulder protraction. In addition to treatments for UE volume reduction in lymphedema patients, accurate posture evaluation is also recommended.