上肢运动功能康复：
据文献分析乳腺癌术侧上肢肩关节功能障碍的发病率为48%，而肩关节功能占上肢功能的60%，因此出现肩关节功能丧失一侧上肢功能削弱很大部分，给患者生活带来诸多不便。肩关节功能障碍的主要临床表现为：肩关节前上抬、外展、内旋、外旋方向活动度不同程度受限，胸大小肌切除患者以上举、外展、内旋活动度受限，可伴肌力下降；日常生活能力下降：表现为梳头、扎头发、穿内衣等动作困难，且运动后容易疲劳；心理问题：患者常因肩部疼痛、活动受限而感到焦虑、失眠、担心肿瘤复发，产生巨大心理压力。此外，患者可因疼痛、淋巴水肿、腋网综合征等原因出现上肢功能限制，应作相应处理。
多个临床随机对照试验证明乳腺癌术后早期进行温和主动运动或物理治疗，有利于改善肩关节活动度、缓解疼痛、预防淋巴水肿，并不增加水肿风险。Harris专家提出上肢功能康复：术前应进行双侧上肢功能评估，以提供一个基线值。手术后的第一天开始进行物理治疗。手术后的第一个星期鼓励患者进行温和的运动练习。主动伸展运动可以在手术后的第一周开始，并且应该持续6到8周，或者直到上肢可完成全部的运动角度。疤痕组织可予以按摩。术后评估应定期进行。渐进的阻力练习，可以在手术后4到6周内开始。多个前瞻性临床试验结果证明运动训练有助于改善肩关节活动度[3-5,7-11,13-20]。1篇meta分析结果显示结在患有乳腺癌的女性中，运动具有明显的实施锻炼[1],但需要仔细权衡运动强度，以避免伤口引流量和持续时间的增加。1小样本的RCT认为针灸未见改善乳腺癌术后肩关节活动度[6]，1荟萃分析显示针灸可改善化疗药物引起的肩关节炎疼痛从而改善关节活动度[2]。
运动训练：温和主动运动/渐进性抗阻运动可用于乳腺癌术后上肢运动共功能障碍（I级推荐，A级证据）
针灸：（IIb级推荐，C级证据)
激光治疗、电刺激、微波和热疗（III级推荐，C级证据)
腋网综合征
腋窝网状综合征（Axillary web syndrome AWS）最初被定义为一种放射向同侧手臂以腋窝疼痛、肩关节活动限制，以及腋窝网线状组织，在体格检查中患者试图外展手臂时最明显，但目前仍然缺乏对AWS的金标准定义。根据文献作者对AWS的描述：腋窝皮肤覆盖了1个或多个”绳子”样线，这些“线”感觉像绳子，条带，肌腱，琴弦，或紧绷的电线。这些“线”/条索可以放射状穿过腋窝，并延伸到前臂和手腕的表面。通常情况下，AWS在腋下手术后的前8周内出现，在术后的12周内症状消失。但一些研究中指出AWS在术后12周到2年出现或持续存在。出现AWS会影响到肩部外展，如果患者在接受胸部和/或腋窝放射治疗，常常达不到所需上肢体位摆放要求。AWS流行病学有很大的差异，从6%到85.4%，一项META分析中指出中位发病率在36%-37%[59]。在接受前哨淋巴结活检（SLNB）出现AWS的患者中有16%患者肩关节活动受限，接受腋窝清扫出现AWS的患者中有64%患者肩关节活动受限[60]。
物理治疗：单个随机对照试验显示PT联合淋巴引流手法有效[8]，一些个人的案例报告描述了AWS的管理：主动和被动的肩部运动，包括温和的伸展运动[57,58]。（IIa级推荐，B级证据)
乳腺癌上肢淋巴水肿
淋巴水肿是治疗后的一种并发症，乳腺癌手术治疗或放射治疗后，或淋巴系统的某些其他损害，导致淋巴通路部分破坏或堵塞，淋巴液积聚，积聚在组织中，引起肿胀。对于乳腺癌患者来说，淋巴水肿在上肢最常见，有时在胸部和/或胸壁，治疗后长达30年也可出现，在术后3-5年发病率最高。由于诊断的差异，患者的特征，以及随访的不足，在乳腺癌后的手臂淋巴水肿的总体发病率从8%到56%不等。与没有淋巴水肿的乳腺癌幸存者相比，患有手臂淋巴水肿的乳腺癌幸存者存在生活质量下降。上肢淋巴水肿患者的可出现肩关节活动受限、上肢疼痛、及肌力下降。
淋巴水肿消肿治疗，包括手法淋巴引流、绷带加压包扎、压力衣、间歇气压治疗，低能量激光、肌内效贴、针灸、抗阻运动等。
1、绷带加压包扎、徒手淋巴引流手法、压力衣：多个RCT比较了此三种方法的优劣，研究证实绷带加压包扎消肿、降低肢体围度效果优于手法及压力衣，淋巴引流手法在早期可预防及促进淋巴回流，但降低肢体围度上无明显效果[24,30,31,33,34,38,39,40]。研究中多以三种治疗方法组合。（I级推荐，A级证据）
2、低能量激光：多个RCT，1篇meta分析[41]，显示了低能量激光在消除水肿有效性[42-46]；
3、间歇气压治疗intermittent pneumatic compression:1项荟萃分析未显示有效性[48]，多个RCT显示有效的协同消肿作用[49-53]。（IIa级推荐，A级证据）
4.肌内效贴：有限的小样本RCT[31]，显示有效。（III级推荐，C级证据）
5.针灸：1项随机试验显示未见消肿效果，2项小样本RCT显示有一定疗效。（IIb级推荐，B级证据）
6.运动锻炼：多个RCT征证实渐进性抗阻运动无消肿治疗效果，但可改善关节活动度、提高生活质量[21,22,23,29,32,35,36]。（III级推荐，A级证据）
淋巴水肿评估：
淋巴水肿评估:客观评估工具有水置换法、臂围测量法、Perometry、生物电阻抗测量BIS、组织介电常数测量、B超、MRI、淋巴闪烁造影等，主观包括问卷评估患者主观感受。临床常见臂围测量，目前还有BIS，3D打印，组织介电常数,专家共识[63,64,65]。（I级推荐，C级证据）。
疼痛/化疗相关周围神经病变：
乳腺癌患者疼痛患病率从40%到89%不等，严重影响患者生活质量[61]。化疗相关周围神经病变CIPN文献报道30-40%患者出现周围神经病变[62]。这些问题在一定程度上可影响手功能，临床上应做对应处理。
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