Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors (original) (raw)
Related papers
Effects of Breast Cancer Treatment on Shoulder Function: What to Expect and How to Treat?
International Journal of Physical Therapy & Rehabilitation, 2018
Breast cancer treatment may lead to side effects such as shoulder pain, restricted shoulder mobility, fibrosis, breast cancer-related lymphedema, and anatomical and biomechanical changes of the shoulder, which will contribute to functional status limitations. Function of the upper limb requires adequate mobility of the shoulder, including the scapula, and an efficient neuromuscular coordination. Movement deviation patterns in women following surgery for breast cancer are similar to those seen in other known shoulder conditions. Exercise therapy and scapular stabilization exercises were found to be an effective approach for controlling pain, promote normal motor control and decreasing disability. The main purpose of the present paper is to review the shoulder movement dysfunctions after breast cancer treatment and to briefly characterize the main physical therapy intervention strategies to treat or prevent these dysfunctions.
Journal of Cancer Survivorship, 2011
Introduction Deficits after breast cancer treatment have been examined by comparing the surgically affected upper extremity to the unaffected extremity. It is not possible to know precisely if anti-cancer treatment such as radiation and chemotherapy had any effect on the unaffected arm. The purpose of this study was to compare ROM, strength, and shoulder function between breast cancer survivors and healthy, matched controls. Methods Shoulder pain and function was assessed using the Disabilities of the Arm Shoulder Hand (DASH) and the Pennsylvania Shoulder Score (PSS). Active and passive range of motion (ROM) for shoulder flexion, extension, external rotation (ER) at 0°and 90°of abduction, internal rotation (IR) at 90°of abduction were measured on the affected side using a digital inclinometer. Strength was measured using a hand held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, internal rotation, ER, scaption, and horizontal adduction. Results Significant differences were found between the two groups for the DASH (p<0.001) and PSS (p<0.001), active flexion (p<0.001), 90°ER (p=0.020), extension (p=0.004) and passive flexion (p<0.001) and 90°ER (p=0.012). All 7 of the shoulder girdle strength measures were significantly different between groups for abduction and upward rotation (p=0.006), depression and adduction (p=0.001), flexion (p< 0.001), ER (p=0.004), IR (p=0.001), scaption (p<0.001), and adduction (p<0.001). Discussion/Conclusions These results provide preliminary evidence to suggest clinicians focus on these particular ROM, strength, and shoulder function measures when treating a breast cancer survivors. Implications for Cancer Survivors Shoulder ROM, strength, and function are important to assess in BCS.
Shoulder movement after the treatment of early stage breast cancer
Clinical Oncology, 1998
At 18 months after surgery and postoperative radiotherapy, the function of the ipsilateral shoulder joint was assessed both subjectively and objectively in 141 patients with early stage breast cancer. Half of the patients said that function was reduced compared with before (any) treatment. Overall, 48% had measured limitation of at least one shoulder movement. Mastectomy patients had more problems than those who had a wide local excision (79% versus 35%) as did those (node positive patients) who had axillary irradiation (73%) compared with those who did not (35%). Patients with dysfunction of shoulder movement before radiotherapy had a 60% chance of persistent movement problems at 18 months, compared with 24% of those with normal postoperative function. Informal exercise did not appear to have had any impact on the development of movement limitation.
https://www.ijhsr.org/IJHSR\_Vol.12\_Issue.3\_March2022/IJHSR-Abstract.018.html, 2022
Early breast cancer treatment can cause shoulder dysfunction, which is a well-known and prevalent adverse effect (1). In individuals treated surgically for breast cancer, physiotherapy was found to enhance shoulder function considerably (1). Breast cancer is the most common type of cancer in women and the leading cause of death and morbidity (2). Every year, 1.67 million new instances of breast cancer are identified worldwide, with 458,000 fatalities (2). Although 89 percent of breast cancer survivors live for at least five years after treatment, side symptoms can continue for months or even years(2). The most common upper-limb side effects are pain and joint dysfunction, with prevalence rates ranging from 12% to 51% for pain and 1.5 percent to 50% for joint dysfunction. Surgery is the most common treatment for primary breast cancer. Shoulder exercises are commonly advised to reduce mobility and strength loss as well as prevent lymphedema. Several clinical services have been developed to help with shoulder range of motion rehabilitation and secondary lymphedema prevention(3). The goal of this study was to see how additional postoperative physiotherapy affected shoulder function after the initial postoperative healing period, especially when given for a longer period. Patients who have had a mastectomy are always at risk of getting shoulder pain and adhesive capsulitis, and they must take precautions (3).
PLoS ONE, 2014
Background: Breast cancer is the most common type of cancer in women in the developed world. As a result of breast cancer treatment, many patients suffer from serious complaints in their arm and shoulder, leading to limitations in activities of daily living and participation. In this systematic literature review we present an overview of the adverse effects of the integrated breast cancer treatment related to impairment in functions and structures in the upper extremity and upper body and limitations in daily activities. Patients at highest risk were defined.
Measurement of objective shoulder function following breast cancer surgery: a scoping review
Physical Therapy Reviews, 2020
Background: Decreased shoulder function is frequently experienced by breast cancer survivors following surgery, and it is associated with both decreased ability to perform daily living tasks and decreased overall quality of life, even several years post-surgery. Shoulder function is often measured with self-reported questionnaires. If objective measurements are taken, they are frequently restricted to range of motion measurement in the cardinal planes of movement. It is not known to what extent shoulder motion in more functional tasks has been investigated. Objectives: This review aims to determine what is known about the objectively evaluated shoulder function following breast cancer and to determine what are the most frequently used methods for evaluation. Methods: This protocol outlines the steps that will be taken to conduct a high quality scoping review on the objective measurement of shoulder function in breast cancer survivors. A comprehensive search of several databases will be performed to identify all relevant research. All identified studies will be screened and those including the objective measurement of shoulder function of breast cancer survivors post-surgery will be included. Data will be extracted by two reviewers and results will be consolidated and presented in narrative form as well as tables and figures. Conclusion: The resulting synthesis of the literature will provide a comprehensive overview of the current methods of evaluating shoulder function in breast cancer survivors. This review will elucidate gaps in knowledge regarding objective measurement of shoulder function and help to develop future research questions.
Physical Therapy Reviews, 2017
Background: Decreased shoulder function is frequently experienced by breast cancer survivors following surgery, and it is associated with both decreased ability to perform daily living tasks and decreased overall quality of life, even several years post-surgery. Shoulder function is often measured with self-reported questionnaires. If objective measurements are taken, they are frequently restricted to range of motion measurement in the cardinal planes of movement. It is not known to what extent shoulder motion in more functional tasks has been investigated. Objectives: This review aims to determine what is known about the objectively evaluated shoulder function following breast cancer and to determine what are the most frequently used methods for evaluation. Methods: This protocol outlines the steps that will be taken to conduct a high quality scoping review on the objective measurement of shoulder function in breast cancer survivors. A comprehensive search of several databases will be performed to identify all relevant research. All identified studies will be screened and those including the objective measurement of shoulder function of breast cancer survivors post-surgery will be included. Data will be extracted by two reviewers and results will be consolidated and presented in narrative form as well as tables and figures. Conclusion: The resulting synthesis of the literature will provide a comprehensive overview of the current methods of evaluating shoulder function in breast cancer survivors. This review will elucidate gaps in knowledge regarding objective measurement of shoulder function and help to develop future research questions.
Breast Cancer Research and Treatment, 2010
Purpose-To determine the extent and time course of upper limb impairment and dysfunction in women being treated for breast cancer, and followed prospectively, using a novel physical therapy surveillance model post-treatment. Patients and Methods-Subjects included adult women with newly diagnosed, untreated, unilateral, Stage I to III BC and normal physiological and biomechanical shoulder function. Subjects were excluded if they had a previous history of BC, or prior injury or surgery of the affected upper limb. Measurements included body weight, shoulder ranges of motion (ROM), manual muscle tests, pain levels, upper limb volume, and an upper limb disability questionnaire (ULDQ). Measurements were taken at baseline (pre surgery), and one, three-six, and 12 months post surgery. All subjects received pre-operative education and exercise instruction and specific physical therapy (PT) protocol after surgery including ROM and strengthening exercises. Results-All measures of function were significantly reduced one month post surgery, but most recovered to baseline levels by one year post surgery. Some subjects developed signs of lymphedema 3-12 months post surgery, but this did not compromise function. Shoulder abduction, flexion, and external rotation, but not internal rotation ROM, were associated with the ULDQ. Conclusion-Most women in this cohort undergoing surgery for BC who receive PT intervention may expect a return to baseline ROM and strength by three months. Those who do not reach baseline, often continue to improve and reach their pre-operative levels by one year post surgery. Lymphedema develops independently of shoulder function three to 12 months post surgery, necessitating continued monitoring. A prospective physical therapy model of surveillance allows for detection of early and later onset of impairment following surgery for BC in this specific cohort of patients.
Journal of Surgical Oncology, 2010
Background and Objectives: To investigate the prevalence of upper limb dysfunction (ULD) and subtypes after breast cancer surgery and to identify factors associated with late ULD. Methods: Among 191 enrolled patients, 191 were evaluated at 3 months, 187 at 6 months, and 183 at 12 months after surgery. Pain, shoulder range of motion, muscle strength, and arm circumference were assessed. Based on symptoms and physical examinations, the types of ULD common after breast cancer treatment were diagnosed and categorized. Results: The prevalence of ULD after surgery were 24.6%, 20.9%, and 26.8% at 3, 6, and 12 months, respectively. The most common types of ULD were pectoralis tightness at 3 and 6 months and lymphedema at 12 months. Patients with pectoralis tightness or lymphedema at 3 or 6 months showed a higher prevalence of rotator cuff disease at 12 months compared with those without early pectoralis tightness or lymphedema. Conclusions: The major post-operative ULD were pectoralis tightness at 3 and 6 months and lymphedema at 12 months. Late ULD such as rotator cuff disease were associated with pectoral tightness or lymphedema at earlier stages. Diagnosis and treatment of ULD should take place as soon as possible after surgery.