Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors
Section snippets
Introduction and overview
In the United States approximately 200,000 women are diagnosed with breast cancer each year [1]. Improvements in the medical management of these women have resulted in a 5-year survival rate of 89 percent, and currently over 2.6 million breast cancer survivors reside in the United States [1]. While survivorship has increased, shoulder and arm morbidity has become a significant complication following curative treatment. Wide prevalence ranges for shoulder/arm pain (9–68%), restricted motion
Diagnosis and treatment of symptomatic rotator cuff disease
Information gathered from the history and physical examination is used to help determine if an individual has symptomatic rotator cuff disease, and if so, attempt to establish the extent of the disease (i.e. tendonitis or tendon tear). Overall, individuals with symptomatic rotator cuff disease complain of shoulder pain, limited motion, and/or weakness as well as decreased functional use of their upper extremity. Pain tends to be located to the anterior or anterolateral aspect of the shoulder
Etiological factors associated with rotator cuff disease
The rotator cuff muscles (subscapularis, supraspinatus, infraspinatus, and teres minor) are essential for normal function of the shoulder girdle (Fig. 1). These muscles are important for the production and control of glenohumeral joint motions including but not limited to shoulder flexion, abduction, internal, and external rotation. Additionally, these muscles are essential for establishing an optimal relationship between the humeral head and glenoid fossa, which in turn, helps to maintain the
Breast cancer and symptomatic rotator cuff disease
The information in this section is separated into subsections to allow us to discuss how each factor could, in and of itself, contribute to the development of symptomatic rotator cuff disease. Although the information in each subsection is presented separately, it is important to recognize that each factor is likely to influence another (i.e. altered resting shoulder alignment and shoulder range of motion) with the end result being a combination of factors contributing to the development of
Conclusions and future research
Shoulder and arm morbidity present a significant problem for women who have had curative breast cancer treatment. While recognition of this problem and the negative effects it has on upper extremity function and health related quality of life is important, the identification of, and referral for, shoulder and arm impairments is not happening frequently enough [90]. Although the reasons for this problem have not been identified it is reasonable to believe that patients and health care providers
Conflicts of interest statement
None declared.
References (90)
- et al.
Late morbidity after treatment of breast cancer in relation to daily activities and quality of life: a systematic review
Eur J Surg Oncol
(2003) - et al.
Health-related quality of life in disease-free survivors of breast cancer with the general population
Ann Oncol
(2007) - et al.
Shoulder impingement syndrome: preoperative health status
J Shoulder Elbow Surg
(2000) - et al.
The impact of rotator cuff pathology on isometric and isokinetic strength, function, and quality of life
J Shoulder Elbow Surg
(2004) - et al.
Rotator cuff tendonitis in lymphedema: a retrospective case series
Arch Phys Med Rehabil
(2004) Rotator cuff disease
Phys Med Rehabil Clin N Am
(2004)- et al.
Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement
Arch Phys Med Rehabil
(2009) Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J
Shoulder Elbow Surg
(2009)- et al.
Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review
J Hand Ther
(2004) - et al.
Glenohumeral stability from concavity-compression: A quantitative analysis
J Shoulder Elbow Surg
(1993)
Age-related prevalence of rotator cuff tears in asymptomatic shoulders
J Shoulder Elbow Surg
Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer
Eur J Surg Oncol
Three-dimensional scapulothoracic motion during active and passive arm elevation
Clin Biomech (Bristol, Avon)
Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo
J Shoulder Elbow Surg
Radiographic assessment of scapular rotational tilt in chronic shoulder impingement syndrome
J Orthop Sci
Scapular behavior in shoulder impingement syndrome
Arch Phys Med Rehabil
Functional activity characteristics of individuals with shoulder dysfunctions
J Electromyogr Kinesiol
Prognosis of the upper limb following surgery and radiation for breast cancer
Breast Cancer Res. Treat.
Factors associated with increased breast cancer-related lymphedema volume
Acta Oncol
A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population
Lymphat Res Biol
Breast lymphedema after breast conserving treatment
Acta Oncol
Barriers to rehabilitation following surgery for primary breast cancer
J Surg Oncol
Short- and long-term recovery of upper limb function after axillary lymph node dissection
Eur J Cancer Care
Objective and subjective upper body function six months following diagnosis of breast cancer
Breast Cancer Res Treat
Arm morbidity and disability after breast cancer: new directions for care
Oncol Nurs Forum
Cancer survivors and unemployment: a meta-analysis and meta-regression
JAMA
The impact of breast cancer among Canadian women: disability and productivity
Work
Lymphedema and quality of life in breast cancer survivors: the Iowa Women’s Health Study
J Clin Oncol
Impact of lymphoedema on arm function and health-related quality of life in women following breast cancer surgery
J Rehabil Med
Functional impact of breast cancer by age at diagnosis
J Clin Oncol
The persistent impact of breast carcinoma on functional health status: prospective evidence from the Nurses’ Health Study
Cancer
Arm/shoulder problems in breast cancer survivors are associated with reduced health and poorer physical quality of life
Acta Oncol
Health-related quality of life before and after a breast cancer diagnosis
Breast Cancer Res Treat
Axilla surgery severely affects quality of life: results of a 5-year prospective study in breast cancer patients
Breast Cancer Res Treat
Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis
Cancer
Changes in arm morbidities and health-related quality of life after breast cancer surgery - a five-year follow-up study
Acta Oncol
Risk of decline in upper-body function and symptoms among older breast cancer patients
J Gen Intern Med
Longitudinal change of treatment-related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: a prospective cohort study
J Surg Oncol
Magnitude of late effects of breast cancer treatments on shoulder function: a systematic review
Breast Cancer Res Treat
The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors
Ann Surg Oncol
Risk factors for arm lymphedema following breast cancer diagnosis in Black women and White women
Breast Cancer Res Treat
Shoulder impairments in patienst with breast cancer: a retrospective review
Rehabilitation Oncology
Evaluation of muscle atrophy after axillary lymph node dissection
Acta Chir Belg
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2020, Clinical BiomechanicsCitation Excerpt :Treatment for breast cancer can cause tissue damage, tissue tightness or fibrosis, or nerve damage to the muscles and tissues around the shoulder and axilla (Bentzen et al., 1989; Hack et al., 1999; Stubblefield and Keole, 2014; Yang et al., 2010), which can be responsible for restricted range of motion, ultimately leading to altered postural alignment and shortened chest muscles. These alterations can change both movement patterns and force generation surrounding the shoulder, as well as decrease the size of the subacromial space, which is a risk factor for rotator cuff disease (Ebaugh et al., 2011). While numerous studies have reported clinical problems after treatment (Assis et al., 2013; Hayes et al., 2005; Kootstra et al., 2013; Kuehn et al., 2000; Lang et al., 2019c), few have measured resulting biomechanical compensations at the shoulder in breast cancer survivors.