Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review

Abstract

Breast cancer is the most commonly diagnosed cancer among women and many women suffer from persistent physical and psychological complaints following their cancer treatment. Altered motor behavior at the shoulder region and upper limb, that is, alterations in movement patterns, spatiotemporal movement characteristics and muscle activation patterns, is a common physical consequence of breast cancer treatment, that can have a clear impact on daily life functioning and quality of life. Furthermore, altered upper limb motor behavior is suggested to relate to upper limb pain, which is very commonly reported in breast cancer survivors (BCS). This review, prepared according to the SANRA guidelines, looks into the current understanding of alterations in motor behavior at shoulder and upper limb in BCS, by discussing the factors related to this altered behavior. In this, we specifically focus on the relation between motor behavior and pain. Results of our search show that cancer treatment modality is predictive for shoulder range of motion. Furthermore, single prospective studies show depressive symptoms, living alone, being non‐white and low physical activity levels as predicting factors for reduced shoulder range of motion. Pain as factor related to altered motor behavior is only assessed in cross‐sectional research, limiting its interpretation in context of being cause or consequence of motor behavioral adaptations, and on the underlying mechanism explaining their relation. It is concluded that studies which explain the mechanisms how and in which subgroup of BCS motor behavioral alterations are associated with pain at the upper limb, are necessary in future.

Upper-Limb Movement Quality before and after Surgery in Women with Breast Cancer: An Exploratory Study

“…Post-surgery pain severity 1.9 ± 1.0 1 Standard deviation. 2 Disability of Arm, Shoulder, and Hand questionnaire.…”

“…Breast cancer is the most common cancer among women [ 1 ]. Although survival rates are high, many women experience persistent physical problems following treatment [ 2 , 3 , 4 ]. These involve upper-limb (UL) problems (e.g., movement alterations; strength deficits; and altered sensations and pain in the arm, hand, and shoulder), all negatively affecting UL functionality [ 4 ].…”

“…However, persistent UL dysfunctions are reported in a subgroup of breast cancer survivors in the long term, even when acute side effects related to tissue healing should have been resolved [ 4 ]. These persistent, unhelpful UL dysfunctions clearly interfere with women’s ability to perform tasks of daily living and decrease their quality of life [ 2 , 4 , 5 , 6 ].…”

“…Human movement analysis allows for the quantification of altered movement patterns and can be used to evaluate musculoskeletal conditions and function. Altered movement patterns in breast cancer patients reported up to now include specific changes in scapulothoracic kinematics, spatiotemporal movement characteristics, and scapular muscle activation patterns [ 2 ]. However, a pitfall of these techniques is that they often require a laboratory setting, limiting their accessibility.…”

Pain after cancer: Time to move towards a mechanism‐based approach!

“…Both in research and clinical practice, there is no doubt about the change in soft tissue properties due to breast cancer treatments. In the first paper (De Baets et al, 2024), an overview of the reported alterations in motor behavior at the level of the shoulder and upper limb in breast cancer survivors is provided, in combination with the known biopsychosocial mechanisms underlying such altered motor behavior.…”