SCM needling post radiation/surgery

[Ashlee Ford]

I have a patient who underwent surgery for HPU-16 cancer in December of 2018. He had 11 lymph nodes removed from the left side of his neck. He also had radiation from Jan 2019-Feb 2019. He was shown to be in remission and 100% cancer free almost a year ago. He still has issues with lymphedema on the left side of his neck. His biggest complaint is pain and tightness tracing his SCM (this can also be observed and palpated). With his lymphedema, is it contraindicated to dry needle in that area? Will it cause a flare up of his lymphedema?

Thank you!

[Susan Falsone]

Hi Ashlee-
Sorry for the delay here. We were all discussing it and there is not a clear cur answer here. A few things to consider:

1) Is the anatomy changed at all from surgery and radiation. If so, you may want to reconsider needling
2) Have you talked with the referring doc? If not, a phone call is in order to see if there are any concerns
3) Have you talked with the patient and they have given informed consent, understanding the risks of infection, altered anatomy, potential uncontrolled or increased edema, etc? If not, I would reconsider needling.
4) Is blood work,including CBC, WBC, etc all normal?

Ultimately there are a lot of unknowns here. He has a compromised lymphatic that simply may not be able to handle the stress of needling in the area. A great conversation with the doc and allowing the patient to understand the unknowns are paramount in this situation.

I don’t see this population, therefore personally I would not needle this person, even with my fairly extensive experience needling. I would proceed with extreme caution, and great communication, no matter which way you decide to go as a clinician. I would also do a great lit review and see what the literature is suggesting. Not an area I spend my time reading on, but would be worth a great lit review, no doubt.

I know that is not the “yes or no” answer you were most likely looking for. A lot to consider.
Sue

[Susan Falsone]

Hi Ashlee-
More follow up here. A couple of instructors weighed in on this and without significant experience treating this population, they were also hesitant. specifically due to the significant anatomy changes that are made with such extensive lymph node removal. Sounds like the overall feeling from the team is great hesitation.

All the best-
Sue

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