If you have a Stage 3 melanoma removed from your arm, then some lymph nodes are also removed from your armpit. Surgery for melanoma on the arm or chest can interfere with arm movement making it difficult to raise your arm.
If doing arm exercises are failing you, and you live in Brisbane, then book an appointment. We can work together and develop your personalized rehab program.
When arm movement does not improve after 3-4 weeks from surgery, then I believe that rehabilitation should be investigated. Connecting with therapists trained in scars, lymphoedema and shoulder rehab is a very reasonable next step. However, finding the right therapist may require a bit of ingenuity and persistence.
Searching for the right rehabilitation therapist
Just last week, I met a Helen* who was 3 weeks after surgery to remove the melanoma in her forearm and several lymph nodes in her armpit area. She found that she could not straighten her elbow fully and could only get her arm to shoulder height before the pain stopped her.
Having four young children meant that it was difficult to get back to her usual tasks. The surgery was at her right arm and this was the arm and hand that usually took the lead: driving, washing hair, cutting vegetables and the many more tasks of a mother's day. Helen was starting to get a bit worried; exercises were not working.
At the follow-up surgical appointment, Helen mentioned her concerns to the doctor. Helen was surprised to hear that he didn't have a therapist that he could refer her to.
Helen decided she had to take action and so made an appointment with a physiotherapist in her local area. The therapist prescribed arm stretch exercises: "feed the chickens" and "sew the grass seed". Intuitively, Helen knew that exercises were not going to be her answer.
Helen wondered whether this therapist had any specific skills in assessing the root cause of poor arm movement after melanoma surgery. Helen didn't know the answer as she hadn't thought to ask the therapist.
So back to the internet she went and this time wondered "who would be similar to me?" Her answer: breast cancer patients as they have nodes removed from the same location. With additional reading, Helen realized that a lymphoedema therapist might have the skills to help her.
With more reading at many different lymphoedema and breast cancer websites, Helen found that she might need a therapist who had even more skills: lymphoedema care, breast cancer rehab care, scar trained and shoulder trained. Helen's next search: lymphoedema, scar, shoulder, Brisbane resulted in finding my website.
After reading the services I list for breast cancer survivors she felt a degree of hope; she was going to get an assessment of the root cause for her loss of arm movement and treatment options beyond arm stretches.
Find the root causes for loss of movement after melanoma surgery
At the initial consultation, the assessment found two separate areas limiting Helen's arm movement: tightness in the skin at the forearm and adhesions well below the skin, at the armpit.
The skin felt tight in an area 15 cms away from the scar at the forearm. This is because melanoma surgery requires approximately 1cm of the surrounding skin to be removed. This means that the amount of skin is less and therefore skin movement in the area will be less. This reduction in skin movement may be responsible for limitations in arm movement.
The second area was the lymph node surgery at the armpit, which resulted in a different problem: slightly less movement at the healed skin scar, and much more stiffness in the movement at and between the layers of tissues some 3 cm below the skin, where the nodes were removed.
OK, some root causes found: skin changes and adhesions that were severe enough not to resolve with gentle arm stretches. Next is the decision about which rehab treatments should be tried.
Rehabilitation treatments depend on the time since surgery
At 3 weeks, the surgical wounds are still healing. It was important that Helen not use forceful arm stretches or receive deep and firm scar release, as these cause more inflammation and more scar tissue being laid down at the wounds.
Little did Helen know that I had just upskilled in a new taping method developed by Ben Fukui, a Japanese Physical Therapist. What I loved about this new method:
it is gentle, with very low force
specifically targets impairments in skin movement and
can be used in the early healing stage.
Would the B. Fukui taping method work for Helen?
Helen agreed to a trial of the Ben F. taping method. The tape was applied at both the forearm and across the chest using the method of skin stretch in the direction, known as skin lines.
Retesting arm movement within 1 minute of applying the tape showed a change in speed and range of arm movement compared to what was seen at the beginning of the appointment. Helen was able to straighten her elbow and get her arm up beside her ear.
Helen also received instructions forsafe tape removal and reapplication guide over the next 3 weeks (as it was Christmas time and we all go on holidays in Australia!)
What does this mean for you?
Firstly, not everyone will respond in the same way as Helen.
But I hope that Helen's tale of persistence, intuition and internet search experience inspires you to find a therapist who is fully focused on the skills you need.
Find a therapist who is investigating the latest evidence-based assessments and treatments for the diagnosis ( or similar) and side effects you are living with. Add to your search: a) your location and b) investigate online consultation as this might result in new options for you.
Living in Brisbane and need help with recovering movement after melanoma surgery?
Find your root cause and try a couple of different treatment options.
Connect with Denise Stewart at this website (email) to organize your initial consultation.
For Monday appointments at Mater Private Breast Cancer Center ph: 3163 1166
Living outside of Brisbane?
Try the same search method that Helen used.
If this fails, connect with me and we can try a skype consultation. An online consult means that you will be guided to become an active participant in the assessment and treatment process.
* You know her name is not Helen.
PS: I have had lots of practice treating my own melanoma forearm scar.
Denise Stewart
Occupational Therapist
