Arm paresthesia effects following axillary dissection

Arm paresthesia is a tingling and numbing sensation in the skin, sometimes called ‘pins and needles‘. Chronic paresthesia is the result of poorly functioning neurons. For breast cancer patients who have undergone some kind of axillary dissection, the arm paresthesia might be caused by poor circulation or inflammation of surrounding tissues. It is not a serious complication from a medical perspective and will usually resolve itself in due course, but it can be quite irritating and disconcerting for a while.

I have created a newer version of this page with up-to-date material. However, this page still has very useful information.

Arm morbidity is common in breast cancer treatment

Arm morbidity is very common in women undergoing treatments for breast cancer. In fact, close to 90% of breast cancer treatments may result in one of a number of possible upper-extremity complications, including arm paresthesia, neuropathy, rotator cuff tendonitis and adhesive capsulities, and post mastectomy syndrome.

Upper extremity morbidity is common after axillary node dissection during breast cancer staging

Some of the morbidity (discomfort/complications) following axillary lymph node dissection would likely include lymphedema, chronic pain, immobility, and arm paresthesia. In fact, these kinds of side effects to the arm happen in up to 50% of patients who undergo axillary node dissection. By contrast, women undergoing just a sentinel lymph node dissection will experience these complications only about 15% of the time. However, if a breast cancer patient undergoes a complete axillary lymph node dissection, arm morbidity is highly likely (about 75% of cases), with arm paresthesia occuring in about 40% of cases.

Other common post-breat cancer treatment arm effects include neuropathy, adhesive capsulitis, and post mastectomy syndrome

Neuropathy is another common complication of breast cancer treatment which can effect arm mobility. Essentially, neuropathy (often called ‘peripheral neuropathy‘), is associated with damage to the peripheral nerves which relay information between the brain and spinal chord. It can be caused by a number of medical conditions, including cancer, but may also be brought on by some of the chemotherapeutics used to treat breast cancer. Chemotherapy-induced neuropathy can cause upper-extremity pain in breast cancer patients.

Adhesive Capsulitis, sometimes called ‘frozen shoulder‘, is another common breast cancer complication. Any kind of restriction on shoulder motion caused by breast or axillary surgery, radiation treatment, bone metastases, or local tumor recurrence could ultimately lead to restricted passive motion a the glenohumeral joint.

Post-mastectomy Syndrome is a multifaceted disorder in which the patient experiences a wide range of sensations, not only in the area of the surgical scar, but also in the axilla, chest, and upper arm. It is characterized by tightness, aching, stabbing, and burning sensations, and is most likely associated with damage to the intercostobrachial nerve.

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Let’s do some Q&A…

• What are the symptoms that may occur with arm paresthesia? Blistering, numbness or tingling, pain, redness, warmth or swelling, changes in sensation, difficulty walking, extreme sensitivity to touch, impaired coordination, muscle weakness, nerve pain, pain when walking, and sharp pain that may be worse at night. Serious symptoms that might indicate a life-threatening condition are changes in level of consciousness or alertness such as confusion, delirium, lethargy, hallucinations and delusions, chest pain or pressure, difficulty breathing, garbled or slurred or inability to speak, paralysis or inability to move a body part, and sudden change in vision, loss of vision or eye pain. Arm paresthesia can be a symptom of reduced blood flow to the heart and heart attack. Seek immediate medical care (call 911) if you or someone you know have arm paresthesia along with any of the symptoms listed above.
• What causes arm paresthesia? Common causes of arm paresthesia include arm trauma or injury, certain medication (some cancer chemotherapy drugs), exposure to extreme heat or extreme cold, exposure to toxic or poisonous compounds (lead or mercury), injury to the nerve, peripheral neuropathy, pressure on nerve or nerve entrapment. Disease causes include nerve damage such as alcoholic neuropathy, diabetes, guillain-barre syndrome, HIV, lyme disease, multiple sclerosis, rheumatoid arthritis, shingles, systemic lupus erythematosus, or vitamin deficiency (especially vitamin B12 and folate). Some serious or life-threatening causes include heart attack stroke, and transient ischemic attack.
• What are some questions for diagnosing the cause of arm paresthesia? To diagnose your condition, your doctor will ask you several questions related to your arm paresthesia including: How long have you felt the arm paresthesia? Where do you feel the arm paresthesia? Do you have any other symptoms? And what medications are you taking?
• What are the potential complications of arm paresthesia? Brain damage, heart failure, permanent loss of feeling and permanent nerve damage.

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References

1. Maunsell E, Brisson J, Deschênes L. Arm problems and psychological distress after surgery for breast cancer. Can J Surg. (Aug 1993);36(4):315-20.
2. Stubblefield MD, Custodio CM. Upper-extremity pain disorders in breast cancer. Arch Phys Med Rehabil (2006); 87(3 Suppl 1):S96-S99.
3. McCredie MR, Dite GS, Porter L, et al. Prevalence of selfreported arm morbidity following treatment for breast cancer in the Australian Breast Cancer Family Study. Breast 2001;10: 515-22.
4. Posner JB. Neurologic complications of cancer. Philadelphia: FA Davis; 1995.
5. Olson JA Jr, McCall LM, Beitsch P, Whitworth PW, Reintgen DS, Blumencranz PW, Leitch AM, Saha S, Hunt KK, Giuliano AE; American College of Surgeons Oncology Group Trials .Impact of immediate versus delayed axillary node dissection on surgical outcomes in breast cancer patients with positive sentinel nodes: results from American College of Surgeons Oncology Group Trials Z0010 and Z0011. J Clin Oncol.(July 2008)l 20;26(21):3530-5.
6. Kuehn T, Klauss W, Darsow M, et al: Long-term morbidity following axillary dissection in breast cancer patients: Clinical assessment, significance for life quality and the impact of demographic, oncologic and therapeutic factors. Breast Cancer Res Treat (2000) 64:275-286
7. Silberman AW, McVay C, Cohen JS, et al: Comparative morbidity of axillary lymph node dissection and the sentinel lymph node technique: Implications for patients with breast cancer. Ann Surg (2004) 240:1-6

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