Three-dimensional scapulothoracic motion following treatment for breast cancer

Abstract

Varying levels of shoulder morbidity following treatment for breast cancer have been reported. Patients report pain, weakness, tightness and reduced functional capacity. Normal painfree motion of the arm and shoulder requires mobility in the scapulothoracic, glenohumeral, acromioclavicular and sternoclavicular joints. Under healthy conditions elevation of the arm is accompanied by scapula retraction, lateral rotation and posterior tilt. However, when scapulothoracic motion is disproportionate to glenohumeral motion, the potential exists for microtrauma and long term pain. A number of studies on women treated for breast cancer have shown limitations in glenohumeral range of movement and a recent report from our laboratory has shown decreased muscle activity in four key muscles acting on the scapula. However, no study has measured the effect of treatment on three-dimensional (3-D) scapulothoracic motion in relation to glenohumeral motion. 152 women treated for unilateral carcinoma of the breast were included in the study. All patients filled out the Shoulder Pain and Disability Index (SPADI). 3-D-kinematic data for the humerus and scapula was recorded during scaption on the affected and unaffected side. The association between kinematic data, SPADI and covariates was determined using random effects multiple regression techniques. All scapula kinematic parameters were significantly altered on the side of the carcinoma in breast cancer survivors. Both reported levels of pain and dysfunction were associated with altered kinematics. High levels of pain and disability were reported for up to 6 years post surgery. Patients with the left side affected reported higher levels of pain and demonstrated more significant scapulathoracic dysfunction independent of dominance. Altered movement patterns were different for left versus right side affected. Left side affected patients need to be considered as a group of patients at risk of experiencing higher levels of pain and showing greater shoulder dysfunction. Whether cause or effect, pain reports are accompanied by 3-dimensional scapula dysfunction which mimics that of many other shoulder conditions.

Predictors of functional shoulder recovery at 1 and 12 months after breast cancer surgery

“…The rate of self-reported affected upper limb weakness exceeding strength measures in this cohort is in agreement with other research [37,46]. We did not assess strength of the scapular stabilizing muscles but recognize that weakness of the stabilizing muscles rather than the primary shoulder muscles may contribute to the self-reported weakness as reduced scapular muscle strength and altered scapular mechanics have been reported after breast cancer surgery [47][48][49][50]. Reduced muscular endurance rather than strength deficits may also contribute to persistent self-reported weakness [51].…”

Immediate Breast Reconstruction with a Latissimus Dorsi Flap Has No Detrimental Effects on Shoulder Motion or Postsurgical Complications up to 1 Year after Surgery

“…23 Associated with pain, these anatomical modifications often lead to scapulohumeral and glenohumeral functional deficits. [30][31][32] Our study clearly suggests that the additional anatomical manipulation necessary for the latissimus dorsi flap procedure does not further affect shoulder kinematics. Surprisingly, the women who underwent latissimus dorsi flap reconstruction exhibited slightly better range-of-motion recovery than those who did not.…”

Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial

“…However, arm elevation is achieved through movement at the glenohumeral joint with movement of the scapula due to the synchronous operation of the muscles. Following breast surgery, the relationship between the humerus and the scapula can be disturbed, affecting arm elevation [35][36][37]. For example, following breast surgery, women achieve elevation through excessive scapular movement [37].…”

“…Furthermore, there are changes to muscles that stabilize the scapula [35]. These adaptations are particularly noticeable when surgery occurs on the non-dominant side [35][36][37]. Altered kinematics post-operatively may have triggered development of shoulder capsulitis with associated synovial inflammation and subsequent reactive capsular fibrosis.…”