Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0043-1772479
Immobilization, Lymphedema, and Obesity are Predictive Factors in the Development of Adhesive Capsulitis in Breast Cancer Patients
Imobilização, linfedema e obesidade são fatores preditivos no desenvolvimento de capsulite adesiva em pacientes com câncer de mama![](https://www.thieme-connect.de/media/10.1055-s-00030576/202310/lookinside/thumbnails/10-1055-s-0043-1772479_220357-1.jpg)
Abstract
Objective Adhesive capsulitis is a condition characterized by shoulder pain and stiffness. Breast cancer treatment has been linked to the development of this condition, but its mechanisms are still little known. This study's objective was to identify predictors factors associated with the development of adhesive capsulitis in breast cancer patients.
Methods A case control study was performed with women undergoing treatment for breast cancer in a single center. The sampling was nonprobabilistic and consecutive. Adhesive capsulitis was defined as constant pain associated with decreased active and passive shoulder movement in anterior elevation, external rotation at 0°/90° abduction, and internal rotation at 90° abduction. The study group consisted of patients with shoulder pain and range of motion limitations, while the control group consisted of women without any shoulder abnormalities. Sociodemographic and clinical variables were collected. A univariate logistic regression was used to assess the influence of variables on the studied outcome. For p < 0.20, a multivariate logistic regression was used. The probability of null hypothesis rejection was 5%.
Results A total of 145 women were assessed, with 39 (26.9%) on the study group and 106 (73.1%) on the control group. The majority was under 60 years old. In the multivariate analysis, variables correlated to the outcome under study were shoulder immobilization (OR = 3.09; 95% CI: 1.33–7.18; p = 0.009), lymphedema (OR = 5.09; 95% CI: 1.81–14.35; p = 0.002), and obesity (OR = 3.91; 95% CI: 1.27–12.01; p = 0.017).
Conclusion Lymphedema, postsurgery immobilization, and obesity are predictive factors for the development of adhesive capsulitis in breast cancer patients.
Resumo
Objetivo Capsulite adesiva é uma afecção caracterizada por dor e limitação dos movimentos do ombro. O tratamento do câncer de mama está relacionado ao desenvolvimento dessa doença por meio de mecanismos ainda pouco conhecidos. O objetivo do estudo foi identificar os fatores associados ao desenvolvimento de capsulite adesiva em pacientes com câncer de mama.
Métodos Um estudo caso-controle foi realizado com mulheres em tratamento para câncer de mama em um centro único. A amostra foi consecutiva e não-probabilística. A capsulite adesiva foi pré-definida como dor constante e diminuição da amplitude de movimentos em elevação anterior, rotação externa em 0°/90° abdução e rotação interna em 90° abdução. O grupo caso foi constituído por pacientes com dor e limitação de todos os movimentos do ombro, enquanto o controle por pacientes sem qualquer alteração nesta articulação. Variáveis sociodemográficas e clínicas foram coletadas. Foi realizada uma análise de regressão logística univariada para avaliar a influência das variáveis em relação ao desfecho estudado. Para valores de p < 0,20, realizou-se a análise de regressão logística multivariada. A probabilidade de se rejeitar a hipótese nula foi de 5%.
Resultados Foram avaliadas 145 mulheres, sendo 39 casos (26,9%) casos e 106 controles (73,1%). Na análise multivariada, as variáveis associadas ao desfecho estudado foram imobilização do ombro (OR = 3,09; 95% IC: 1,33–7,18; p = 0,009), linfedema (OR = 5,09; 95% IC: 1,81–14,35; p = 0,002) e obesidade (OR = 3,91; 95% IC: 1,27–12,01; p = 0,017).
Conclusão Linfedema, imobilização pós-cirúrgica e obesidade são fatores preditores associados ao desenvolvimento de capsulite adesiva em pacientes com câncer de mama.
Contributions
All of the authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.
Publication History
Received: 29 November 2022
Accepted: 14 July 2023
Article published online:
09 November 2023
© 2023. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
-
References
- 1 Fields BKK, Skalski MR, Patel DB. et al. Adhesive capsulitis: review of imaging findings, pathophysiology, clinical presentation, and treatment options. Skeletal Radiol 2019; 48 (08) 1171-1184 DOI: 10.1007/s00256-018-3139-6.
- 2 Kingston K, Curry EJ, Galvin JW, Li X. Shoulder adhesive capsulitis: epidemiology and predictors of surgery. J Shoulder Elbow Surg 2018; 27 (08) 1437-1443 DOI: 10.1016/j.jse.2018.04.004.
- 3 Chiaramonte R, Bonfiglio M, Chisari S. A significant relationship between personality traits and adhesive capsulitis. Rev Assoc Med Bras 2020; 66 (02) 166-173
- 4 Ramirez J. Adhesive Capsulitis: Diagnosis and Management. Am Fam Physician 2019; 99 (05) 297-300
- 5 Yang S, Park DH, Ahn SH. et al. Prevalence and risk factors of adhesive capsulitis of the shoulder after breast cancer treatment. Support Care Cancer 2017; 25 (04) 1317-1322 DOI: 10.1007/s00520-016-3532-4.
- 6 Mascara M, Constantinou C. Global perceptions of women on breast cancer and barriers to screening. Curr Oncol Rep 2021; 23 (07) 74 DOI: 10.1007/s11912-021-01069-z.
- 7 Borges JBR, Torresan RZ. Breast cancer and hormonal contraception: Should we rethink our concepts?. Rev Assoc Med Bras 2018; 64 (03) 201-203
- 8 Watkins EJ. Overview of breast cancer. JAAPA 2019; 32 (10) 13-17 DOI: 10.1097/01.JAA.0000580524.95733.3d.
- 9 Ebaugh D, Spinelli B, Schmitz KH. Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. Med Hypotheses 2011; 77 (04) 481-487 DOI: 10.1016/j.mehy.2011.06.015.
- 10 Rasmussen GHF, Madeleine P, Arroyo-Morales M, Voigt M, Kristiansen M. Pain sensitivity and shoulder function among breast cancer survivors compared to matched controls: a case-control study. J Cancer Surviv 2021; ••• : online ahead of print DOI: 10.1007/s11764-021-00995-y.
- 11 Koehler LA, Hunter DW, Blaes AH, Haddad TC. Function, shoulder motion, pain, and lymphedema in breast cancer with and without axillary web syndrome: an 18-month follow-up. Phys Ther 2018; 98 (06) 518-527 DOI: 10.1093/ptj/pzy010.
- 12 Vehmas T, Shiri R, Luoma K, Viikari-Juntura E. The relations of obesity indicators and early metabolic disturbance with upper extremity pain. Pain Med 2013; 14 (07) 1081-1087 DOI: 10.1111/pme.12132.
- 13 Saklayen MG. The global epidemic of the metabolic syndrome. Curr Hypertens Rep 2018; 20 (02) 12 DOI: 10.1007/s11906-018-0812-z.
- 14 Itoi E, Arce G, Bain GI. et al. Shoulder stiffness: current concepts and concerns. Arthroscopy 2016; 32 (07) 1402-1414 DOI: 10.1016/j.arthro.2016.03.024.
- 15 Le HV, Lee SJ, Nazarian A, Rodriguez EK. Adhesive capsulitis of the shoulder: review of pathophysiology and current clinical treatments. Shoulder Elbow 2017; 9 (02) 75-84 DOI: 10.1177/1758573216676786.
- 16 Recchia TL, Prim AC, Luz CM. Upper limb functionality and quality of life in women with five-year survival after breast cancer surgery. Rev Bras Ginecol Obstet 2017; 39 (03) 115-122 DOI: 10.1055/s-0037-1598642.
- 17 Kim KH, Yeo SM, Cheong IY, Kim Y, Jeon BJ, Hwang JH. Early rehabilitation after total mastectomy and immediate reconstruction with tissue expander insertion in breast cancer patients: A retrospective case-control study. J Breast Cancer 2019; 22 (03) 472-483 DOI: 10.4048/jbc.2019.22.e40.
- 18 Yang A, Sokolof J, Gulati A. The effect of preoperative exercise on upper extremity recovery following breast cancer surgery: a systematic review. Int J Rehabil Res 2018; 41 (03) 189-196 Doi: 10.1097/MRR.0000000000000288
- 19 Reigle BS, Zhang B. Women's rehabilitation experiences following breast cancer surgery. Rehabil Nurs 2018; 43 (04) 195-200 Doi: 10.1097/rnj.0000000000000168
- 20 Testa A, Iannace C, Di Libero L. Strengths of early physical rehabilitation programs in surgical breast cancer patients: results of a randomized controlled study. Eur J Phys Rehabil Med 2014; 50 (03) 275-284
- 21 Scaffidi M, Vulpiani MC, Vetrano M. et al. Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery. Eur J Phys Rehabil Med 2012; 48 (04) 601-611
- 22 Jang D-H, Kim M-W, Oh S-J, Kim JM. The Influence of Arm Swelling Duration on Shoulder Pathology in Breast Cancer Patients with Lymphedema. PLoS One 2015; 10 (11) e0142950 DOI: 10.1371/journal.pone.0142950.
- 23 Jeong HJ, Sim YJ, Hwang KH, Kim GC. Causes of shoulder pain in women with breast cancer-related lymphedema: a pilot study. Yonsei Med J 2011; 52 (04) 661-667 DOI: 10.3349/ymj.2011.52.4.661.
- 24 Stubblefield MD, Keole N. Upper body pain and functional disorders in patients with breast cancer. PM R 2014; 6 (02) 170-183 DOI: 10.1016/j.pmrj.2013.08.605.
- 25 Fernandes MR. Patient-reported measures of quality of life and functional capacity in adhesive capsulitis. Rev Assoc Med Bras 2017; 63 (04) 347-354