2. INTRODUCTION
Shoulder dysfunction is a condition in which the
muscles of shoulder are weakened. This can occur
when the muscles is damaged or affected by
cancer treatment.
Shoulder dysfunction and pain following breast
cancer treatment is common, impacting upon
postoperative quality of life
Helen Richmond et al .,2017Development of a complex exercise intervention for
prevention ofshoulder dysfunction in high-risk women following treatment for
breast cancer: prevention of shoulder problems trial (PROSPER)
3. FACTS
20%-33% of breast
cancer patients
report pain and
dysfunction of
shoulder after
primary treatment.
Breast cancer
treatment is risk of
developing
impaired muscles
of shoulder girdle
leads to
dysfunction.
6. CAUSES OF JOINT STIFFNESS
SURGERY
• After surgery patient is
unable to move the arm
due to pain which results
in stiffness.
RADIATION
• Effects of radiotherapy
that direct influence
limitations in shoulder
function leads to fibrosis
of joint causes stiffness
and tightness.
7.
8. -sentinel node biopsies along with lymph node dissection impact
triceps, latissimus dorsi, teres major and minor, subscapularis, and
serratus anterior. Insult to these structures creates dysfunction of
the rotator cuff and scapula-humeral rhythm.
– due to radiation therapy muscles and connective tissues within
the shoulder joint can lead to the formation of fibrosis and
atrophy leads to restriction of joint and pain.
chemotherapy induced results in rotator cuff tendonitis
CAUSES OF ROTATOR CUFF
TENDONITIS
10. CAUSES OF BRACHIAL
PLEXOPATHY
Radiation-induced
damage to the
brachial plexus can
occur in patients
who have had
radiation therapy
for neoplasm of the
mediastinum,
breast, lymph nodes
Radiation effects to
the plexus usually
progress insidiously
and may involve the
entire plexus.
The occurrence of
radiation induced
brachial plexopathy
is dependent on the
radiation dose
,treatment
technique and
concomitant use of
chemotherapy.
11. PATHOPHYSIOLOGY
The pathophysiology of RIBN is not fully understood,
though it is thought that direct nerve injury results
from radiation-induced capillary network disruption.
12. CLINICAL PRESENTATION
--Loss Of ROM
--Pain
--Decrease
Muscle
Strength
--Restricted
ROM
--Reduced
Muscle
Strength
--Positive Neer
Sign And
Hawkins Test
---Weakness
--Pain
--Loss Of Movement
--Tingling
--Numbness
--A Flaccid,
Nonfunctional Arm With
Profound Lymphedema
Is Characteristic Of
Radiation Induced
Brachial Plexopathy.
13. ASSESSMENT
Patient referred for shoulder rehab
post Breast Cancer Intervention
Active ROM Passive ROM
Rotator cuff
tendonitis?
Joint stiffness/ Frozen
Shoulder?
If
restricte
d/Painful
Assess Active & Passive ROM,
Manual Muscle Testing
If
restricte
d/Painful
Special Test to
Confirm
Check for Capsular
Pattern
Manual Muscle
Testing
Generalized Weakness/
Postsurgical muscle
atrophy
If overall
weakness
If weakness to specific group
of muscles/ Neural Pattern
Brachial Plexopathy?
Check for Dermatome
& Myotome Patterns
17. MANAGEMENT OF JOINT STIFFNESS
Rom Exercises of Shoulder Joint
Rom Exercises of
Shoulder Joint
Shoulder
blade squeeze
and stretch
Shoulder
Stretch
Pulley
exercise
Shoulder
ladder
Exercise
18. MANAGEMENT OF JOINT STIFFNESS
MOBILISATION
GLIDES
INFERIOR GLIDE
ANTERIOR GLIDE
OSCILLATIONS
GRADE 2
LARGE
AMPLITUDE UPTO
THE RANGE
AMERICAN ASSOCIATION
19. MANAGEMENT OF ROTATOR CUFF TENDINITIS
• Rest
• Cryotherapy
• ROM exercises of shoulder joint
• Strengthening of-
i. Humeral head stabilisers
ii. Scapular stabilisers
iii. Supraspinatus
• Pendulum swings
• Cross over arm stretch
• Wand exercises
• Posterior capsule stretch
Stephens M Simons,MD,FACSM,Michael Roberts,MPT,CSCS Mar 07,2020
20. SPECIAL TECHNIQUES FOR
MANAGEMENT OF ROTATOR CUFF TENDONITIS
MANAGEMENT
OF ROTATOR
CUFF
Muscle
Energy
techniques
Myofascial
release
Taping
Ischemic
compression
25. MANAGEMENT OF
BRACHIALPLEXOPATHY
Initial management is focused on stabilizing and maintaining the function of the
shoulder girdle.
Balanced forearm orthoses may be used to assist in activities of daily living when
shoulder function is lost.
Shoulder support to avoid subluxation and overload of the shoulder girdle may
benefit patients.
Patients losing hand function may benefit from orthotic devices or modification of
utensils to maintain hand function.
Sensory loss is the earliest symptom and is identified in the medial arm, medial
forearm, and fourth and fifth digits
26. Breast Cancer
Shoulder Rehabilitation
Soft Tissue Mobility
• Trigger Points (pectoralis major
& minor; serratus anterior;
subscapularis, latissims dorsi,
teres major & minor, triceps)
• Watch for axillary coding
Rib Mobility & Breathing Exercises
• Restore mobility and prevent
restriction
• Breathing assists in maintaining
ribs mobility; facilities
reactivation of diaphragm
Lymphatic System Support
Local Lymph drainage to prevent
lymphedema
Scapula Mobility
Maintains or re-established
scapula-humeral rhythm
disrupted by soft tissue
restrictions &/o inhibition from
pain/trigger points
MUSCULOSKELETAL REHABILITATION
A novel conceptual framework for rehabilitation of functional deficits
for breast cancer survivors
Majorie A.king Claudio l.battaglini 18 july2019
27. CONCLUSION
Shoulder dysfunction and pain following breast cancer treatment is common,
impacting upon postoperative quality of life.
To improve these dysfunctions and quality of life, early assessment and
rehabilitation are essential.
To correct or to prevent this dysfunction, physiotherapy is must to be needed.
Manual therapy can achieve greater ROM ,reduce breast cancer cancer
rehabilitation times,and improve patient outcomes.
Exercises help to improve QOL, avoidance of secondary complications,
Improve the activity of daily living.
Prevalence Of Myofascial Dysfunctions In Breast
Cancer Survivors
Sapana Namadev Jare
28. PREVENTION OF SHOULDER
DYSFUNCTION
Pre –rehabilitation exercises should be done to reduce the Effect of breast cancer
treatment
Patient education should be done regarding post operative pain , effectiveness of
exercises after the treatment( surgery, radiation and chemotherapy)
Exercises on the cycloergometer, strengthening of shoulder muscles and postural
reeducation implemented after one week of surgery, which should be used for 6-8
weeks
In practical guidelines for the rehabilitation of women in breast cancer after surgical ,
radiation and chemotherapy of breast cancer, it is recommended to train progressive
resistance exercise from the 4th or 6th week after surgery.
Samusik K. Selected problems in rehabilitation
patients with breast cancer. Rehabilitation Practice
2010
