Shoulder Pain and Disability Among Post Mastectomy Patients

Abstract

Purpose The purpose of this study was to determine shoulder pain and disability among post mastectomy patients.

Methods This cross sectional study was conducted in Peshawar Pakistan from June 2017 to June 2018. A self administered questionnaire was used to collect demographic information and clinical characteristics while Shoulder Pain and Disability Index (SPADI) was used to evaluate shoulder pain and disability. Female post mastectomy patients with age between 18 to 55 years were included. Patients with co-morbidities, bilateral mastectomy, history of trauma, history of shoulder pain before mastectomy and shoulder pain on non-operated side were excluded. SPSS version 23 was used to analyze the data.

Results A total of 127 post mastectomy patients participated in the study. Out of total 127 participants, 99 (77.95%) reported shoulder pain and disability on operated site. Age (P value=0.181) and operated side i. e., right and left mastectomy (P value=0.324) were not significantly associated with shoulder pain and disability. On the other hand marital status (P value=0.04), educational status (P value=0.03) profession (P value<0.001) and time since surgery (P value=0.04) were significantly associated with shoulder pain and disability.

Conclusion More than 2 third of post mastectomy patients suffer from shoulder pain and disability. Connective tissue fibrosis of shoulder joint seems to be the only reason for it. Physical therapy after mastectomy can help in preventing shoulder pain and disability.

Zusammenfassung

Ziel Ziel dieser Studie war die Ermittlung von Schulterschmerzen und Funktionseinschränkungen bei Patientinnen nach Mastektomie.

Methodik Diese Querschnittsstudie wurde von Juni 2017 bis Juni 2018 in Peshawar, Pakistan, durchgeführt. Demografische Informationen und klinische Daten wurden mittels Fragebogen erhoben, der von den Patientinnen ausgefüllt wurde. Um Schulterschmerzen und Funktionseinschränkungen zu beurteilen, wurde der Shoulder Pain and Disability Index (SPADI) verwendet. In die Studie wurden Patientinnen nach Mastektomie im Alter zwischen 18 und 55 Jahren aufgenommen. Ausgeschlossen wurden Patientinnen mit Begleiterkrankungen, bilateraler Mastektomie, Traumata in der Anamnese, Schulterschmerzen vor der Mastektomie und Schulterschmerzen auf der nicht operierten Seite. Zur Analyse der Daten wurde SPSS Version 23 verwendet.

Ergebnisse Insgesamt nahmen 127 Patientinnen nach Mastektomie an der Studie teil. Von insgesamt 127 Studienteilnehmerinnen berichteten 99 (77,95%) über Schulterschmerzen und Funktionseinschränkungen auf der operierten Seite. Das Alter (p = 0,181) und die operierte Seite, d. h. rechts- oder linksseitige Mastektomie (p = 0,324) waren nicht signifikant assoziiert mit Schulterschmerzen und Funktionseinschränkungen. Dagegen konnte eine signifikante Beziehung zwischen Familienstand (p = 0,04), Bildungsniveau (p = 0,03), Beruf (p < 0,001) und Zeit nach Operation (p = 0,04) festgestellt werden.

Schlussfolgerung Mehr als zwei Drittel der Patientinnen nach Mastektomie leiden unter Schulterschmerzen und Funktionseinschränkungen. Der einzige Grund dafür scheint eine Fibrose des Bindegewebes im Schultergelenk zu sein. Eine Physiotherapie im Anschluss an die Mastektomie kann Schulterschmerzen und Funktionseinschränkungen vorbeugen.

Key words

Cancer - disability - mastectomy - pain - physical therapy - shoulder

Schlüsselwörter

Brustkrebs - Funktionseinschränkung - Mastektomie - Schmerzen - Physiotherapie - Schulter

• References

• 1 Springer BA, Levy E, McGarvey C. et al. Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer. Breast cancer research and treatment 2010; 120: 135-147
• 2 Pérez-Palomares S, Oliván-Blázquez B, Pérez-Palomares A. et al. Contribution of Dry Needling to Individualized Physical Therapy Treatment of Shoulder Pain: A Randomized Clinical Trial. journal of orthopaedic & sports physical therapy 2017; 47: 11-20
• 3 Oliveira M, Gurgel M, Miranda M. et al. Efficacy of shoulder exercises on locoregional complications in women undergoing radiotherapy for breast cancer: clinical trial. Brazilian Journal of Physical Therapy 2009; 13: 136-143
• 4 Barnes CP, Lam PH, Murrell GA. Short-term outcomes after arthroscopic capsular release for adhesive capsulitis. Journal of Shoulder and Elbow Surgery 2016
• 5 Badalamente MA. Treatment Options for Patients with Adhesive Capsulitis (Frozen Shoulder). Dupuytren Disease and Related Diseases-The Cutting Edge: Springer 2017; p. 363-369
• 6 Robinson C, Seah KM, Chee Y. et al. Frozen shoulder. J Bone Joint Surg Br 2012; 94: 1-9
• 7 Dudkiewicz I, Oran A, Salai M. et al. Idiopathic adhesive capsulitis: long-term results of conservative treatment. The Israel Medical Association journal: IMAJ 2004; 6: 524-526
• 8 Blomqvist L, Stark B, Engler N. et al. Evaluation of arm and shoulder mobility and strength after modified radical mastectomy and radiotherapy. Acta oncologica 2004; 43: 280-283
• 9 Newman D. editor A prospective survey of injuries at first class counties in England and Wales 2001 and 2002 seasons. Science and medicine in cricket: a collection of papers from the Second World Congress of Science and Medicine in Cricket Port Elizabeth: comPress 2003
• 10 Rundquist PJ, Ludewig PM. Patterns of motion loss in subjects with idiopathic loss of shoulder range of motion. Clinical biomechanics 2004; 19: 810-818
• 11 Neviaser AS, Hannafin JA. Adhesive Capsulitis A Review of Current Treatment. The American journal of sports medicine 2010; 38: 2346-2356
• 12 Fabis J, Rzepka R, Fabis A. et al. Shoulder proprioception – lessons we learned from idiopathic frozen shoulder. BMC musculoskeletal disorders 2016; 17: 1
• 13 Balcı NC, Yuruk ZO, Zeybek A. et al. Acute effect of scapular proprioceptive neuromuscular facilitation (PNF) techniques and classic exercises in adhesive capsulitis: a randomized controlled trial. Journal of physical therapy science 2016; 28: 1219
• 14 Eljabu W, Klinger HM, von Knoch M. Prognostic factors and therapeutic options for treatment of frozen shoulder: a systematic review. Archives of orthopaedic and trauma surgery 2016; 136: 1-7
• 15 Sun Y, Lu S, Zhang P. et al. Steroid Injection Versus Physiotherapy for Patients With Adhesive Capsulitis of the Shoulder: A PRIMSA Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine. 2016; 95: e3469
• 16 Luque-Suarez A, Rondon-Ramos A, Fernandez-Sanchez M. et al. Spanish version of SPADI (shoulder pain and disability index) in musculoskeletal shoulder pain: a new 10-items version after confirmatory factor analysis. Health and quality of life outcomes 2016; 14: 32
• 17 Beyaz SG, Ergönenç JŞ, Ergönenç T. et al. Postmastectomy pain: a cross-sectional study of prevalence, pain characteristics, and effects on quality of life. Chinese medical journal 2016; 129: 66
• 18 Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. The American journal of surgery 2002; 184: 383-393
• 19 Kaur N, Petit J-Y, Rietjens M. et al. Comparative study of surgical margins in oncoplastic surgery and quadrantectomy in breast cancer. Annals of surgical oncology 2005; 12: 539-545
• 20 Skalsky AJ, McDonald CM. Prevention and management of limb contractures in neuromuscular diseases. Physical medicine and rehabilitation clinics of North America 2012; 23: 675-687
• 21 Cheville AL, Tchou J. Barriers to rehabilitation following surgery for primary breast cancer. Journal of surgical oncology 2007; 95: 409-418
• 22 Armer JM, Hulett JM, Bernas M. et al. Best-practice guidelines in assessment, risk reduction, management, and surveillance for post-breast cancer lymphedema. Current breast cancer reports 2013; 5: 134-144
• 23 Crosbie J, Kilbreath SL, Dylke E. et al. Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement. Physical therapy 2010; 90: 679