Change in Shoulder Function in the Early Recovery Phase after Breast Cancer Surgery: A Prospective Observational Study

Abstract

Breast cancer surgery significantly affects the shoulder’s range of motion (ROM) and strength. However, the extent of shoulder impairment, as well as patterns of recovery immediately after surgery, is not fully understood. Therefore, we aimed to investigate shoulder ROM and strength during the early recovery phase after surgery. Thirty-two breast cancer patients were observed five times: the day before surgery, discharge day (postoperative day 1 (POD1) or (POD2)), first outpatient visit (POD7–10), second outpatient visit (POD14–20), and third outpatient visit (POD21–30). We assessed shoulder passive ROM and strength for both affected and unaffected arms at each observation. ROM decreased in both affected and unaffected sides post-surgery. ROM on the affected side did not recover to the pre-surgery level until the third outpatient visit (POD24). In contrast, the ROM on the unaffected side recovered to the pre-surgery level by the first outpatient visit (POD10). The shoulder strength of both arms declined and did not recover to pre-surgery levels. Shoulder strength in the affected arm significantly decreased immediately after surgery (52.9% of the pre-surgery levels) and did not recover until the third outpatient visit (62.5% of the pre-surgery levels), whereas that in the unaffected arm decreased gradually (83.1 ± 2.3 at POD 1 and 78.9 ± 2.9 at POD 24). Descriptively, patterns of recovery in ROM may vary according to types of surgery while patterns of recovery in shoulder strength did not: shoulder strength significantly decreased and did not recover notably regardless of types of surgery. Both shoulder ROM and strength reduced during the early recovery phase after breast cancer surgery regardless of types of surgery, although the degree of reduction was greater in shoulder strength than ROM. Our findings suggest that rehabilitation exercises should be implemented in both upper limbs.

Improvement of Shoulder Motion in Two-Stage Dual-Plane Implant-Based Breast Reconstruction followed by Radiation Therapy through Delayed Prepectoral Conversion

“…According to other studies on shoulder morbidity after mastectomy, shoulder ROM decreases until the first postoperative month and shows gradual improvement until postoperative month 12, when it reaches a plateau. [25][26][27][28] Even though our study focused on the shoulder ROM change after tissue expander-to-implant exchange surgery, not mastectomy, the postoperative shoulder ROM progress in our study is similar to that of other studies, as shown in ►Fig. 4.…”

“…It seems essential to improve patients' shoulder movement to increase the return-to-work rate and quality of life. 25 26 27 Patients who undergo both subpectoral reconstruction and PMRT are more prone to severe shoulder morbidities, which decrease their quality of life. 8 More delicate management is needed to reduce shoulder discomfort, particularly in irradiated patients who undergo subpectoral reconstruction after mastectomy.…”

Impact of Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy on Upper Limb Morbidity in Breast Cancer Patients

“…When shoulder recovery patterns were analyzed by the number of lymph nodes removed, recovery patterns did not differ by the number of lymph nodes. 73 This may suggest that arm positioning during the surgery may have an important role in determining the impact on ROM.…”

Integrating Artificial Intelligence for Improved Management of Frozen Shoulder and Complications in Breast Cancer Surgery: A Perspective from Thailand

“…Interestingly, shoulder Range of Motion (ROM) on the unaffected side also experiences a decrease [22]. Clinically, patients commonly present with shoulder pain and limited ROM, typically manifesting as reduced abduction and internal rotation during both active and passive movements [23,24]. Frozen shoulder is often accompanied by pain, and previous reports indicate that levels of pain and dysfunction correlate with altered kinematics (25).…”