Upper Body Pain and Functional Disorders in Patients With Breast Cancer

Abstract

Upper body pain and dysfunction are common in survivors of breast cancer. Disorders of the upper body can result directly from breast cancer or from the surgery, chemotherapy, radiotherapy, or hormonal therapies used in its treatment. Although considerable information is available regarding impairments such as pain and restricted shoulder range of motion associated with breast cancer and its treatment, relatively little information is available about the specific neuromuscular, musculoskeletal, lymphovascular, and other diagnostic entities that underlie those impairments. This article will detail the common and specific causes of upper body pain and dysfunction in breast cancer survivors, including postsurgical pain, rotator cuff disease, adhesive capsulitis, arthralgias, cervical radiculopathy, brachial plexopathy, mononeuropathy, postmastectomy pain syndrome, lymphedema, axillary web syndrome, deep vein thrombosis, and cellulitis. Diagnostic specificity is a key first step to safely and effectively restore function and quality of life to breast cancer survivors.

Effect of low-level laser therapy on pain and swelling in women with breast cancer-related lymphedema: a systematic review and meta-analysis

“…However, as many practicing clinicians may experience, there is an entire spectrum of pain syndromes that may arise as the result of breast cancer treatment. Other potential causes of pain in breast cancer survivors include cervical radiculopathy, brachial plexopathy, mono-neuropathies, chemotherapy-induced peripheral neuropathy, rotator cuff tendonitis, shoulder adhesive capsulitis, axillary web syndrome, post-mastectomy pain syndrome, post-surgical pain and edema, and bone metastases [29]. Treatments for these conditions are often addressed simultaneously with the treatment of lymphedema.…”

The Orthopedic Burden of U.S. Cancer Care

“…Up to one third of breast cancer survivors report extremity circulation problems [54]. Not including postsurgical pain, patients treated for breast cancer with mastectomy, axillary dissection and/or adjuvant radiotherapy often suffer from adhesive capsulitis, mononeuropathy, rotator cuff disease, lymphedema, radiation osteiitis, and axillary web syndrome [55]. When comparing range of motion and strength between women who had undergone mastectomy versus mastectomy and radiation, 40% of women reported impairment of shoulder function when radiated, 31% for surgery alone.…”

“…Radiation effects may be immediately apparent during the course of treatment, including burns or wounds, or may not become apparent for many years after treatment and evolve into fibrosis, joint contractures, and secondary malignancies. Radiation fibrosis is a major contributor to long term disability, and may mimic adhesive capsulitis, rotator cuff pathology, or brachial plexopathy [55,60]. Radiation-associated neuropathy is much less predictable than chemotherapy-induced neuropathy [61].…”

Physiotherapeutic approach and functional performance after breast cancer surgery

“…ROM limitation is the most common complication after surgery and affects more than half of women both in immediate and late postoperative (6,13). ROM limitation may also cause a negative impact on upper limber (UL) function affecting quality of life (QOL) (14,15).…”