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Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer

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Abstract

In order to determine the extent and time course of upper limb impairment and dysfunction in women being treated for breast cancer (BC), and followed prospectively, a novel physical therapy surveillance model post-treatment was used. Subjects included adult women with newly diagnosed, untreated, unilateral, Stage I to III BC, and normal physiological and biomechanical shoulder function. Subjects were excluded if they had a previous history of BC, or prior injury or surgery of the affected upper limb. Measurements included body weight, shoulder ranges of motion (ROM), manual muscle tests, pain levels, upper limb volume, and an upper limb disability questionnaire (ULDQ). Measurements were taken at baseline (pre-surgery), and 1, 3–6, and 12 months post-surgery. All subjects received pre-operative education and exercise instruction and specific physical therapy (PT) protocol after surgery including ROM and strengthening exercises. All measures of function were significantly reduced 1 month post-surgery, but most recovered to baseline levels by 1-year post-surgery. Some subjects developed signs of lymphedema 3–12 months post-surgery, but this did not compromise function. Shoulder abduction, flexion, and external rotation, but not internal rotation ROM, were associated with the ULDQ. Most women in this cohort undergoing surgery for BC who receive PT intervention may expect a return to baseline ROM and strength by 3 months. Those who do not reach baseline, often continue to improve and reach their pre-operative levels by 1-year post-surgery. Lymphedema develops independently of shoulder function 3–12 months post-surgery, necessitating continued monitoring. A prospective physical therapy model of surveillance allows for detection of early and later onset of impairment following surgery for BC in this specific cohort of patients.

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Acknowledgments

The authors thank Ching-yi A. Shieh, Violeta Gutierrez, Gloria Furst, Wendy Chen, and Beth Rasch for their statistical contributions; and Leighton Chan and Ismail Jatoi for their support of this project. This research was funded by the National Naval Medical Center, 8901 Wisconsin Avenue, Building 10, Breast Care Center, 4th Floor West, Bethesda, MD 20889-5600 (protocol NNMC #B01-052) and the National Institutes of Health, Mark O. Hatfield Clinical Research Center, Rehabilitation Medicine Department, Physical Therapy Section, MSC 1604, 10 Center Dr, Bethesda, MD 20892-1604 (protocol NIH #02-CC-0044).

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Authors and Affiliations

  1. Proponency Office for Rehabilitation and Reintegration, Office of the Surgeon General, 5109 Leesburg Pike, Suite 684, Falls Church, VA, 22041-3258, USA

    Barbara A. Springer

  2. National Institutes of Health, Bethesda, MD, USA

    Ellen Levy

  3. CLM Consulting Services LLC, Rockville, MD, USA

    Charles McGarvey

  4. University of Michigan-Flint, Flint, MI, USA

    Lucinda A. Pfalzer

  5. National Naval Medical Center, Bethesda, MD, USA

    Nicole L. Stout & Peter W. Soballe

  6. George Mason University, Fairfax, VA, USA

    Lynn H. Gerber

  7. George Washington University Medical Center, Washington, DC, USA

    Jerome Danoff

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  1. Barbara A. Springer
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  2. Ellen Levy
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  3. Charles McGarvey
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  4. Lucinda A. Pfalzer
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  5. Nicole L. Stout
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Correspondence to Barbara A. Springer.

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The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official or as reflecting the views of the US Army, the US Navy, the Department of Defense, the US PHS, the NIH, or the US Government.

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Springer, B.A., Levy, E., McGarvey, C. et al. Pre-operative assessment enables early diagnosis and recovery of shoulder function in patients with breast cancer. Breast Cancer Res Treat 120, 135–147 (2010). https://doi.org/10.1007/s10549-009-0710-9

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  • DOI: https://doi.org/10.1007/s10549-009-0710-9

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