title: Considering wider myofascial involvement as a possible contributor to upper extremity dysfunction following treatment for primary breast cancer.
abstract: BACKGROUND
  Breast cancer is the most common malignancy in women. Although scarring is recognized as contributing to limited shoulder movements, compromised tissue gliding in a wider range of fascial and connective tissue structures is under-recognized.
  
  
  OBJECTIVE
  To report on soft tissue patterns in patients with upper limb dysfunction after modified radical mastectomy.
  
  
  METHODS
  Tissue gliding was assessed in the neck, chest wall, abdomen, axilla and upper arm. Scarring, areas and directions of tightness were mapped on upper body charts.
  
  
  RESULTS
  Eighteen shoulders were evaluated. All patients had combinations of restrictive tissue gliding and shoulder movements. Four dominant restrictive areas were identified-surgical scarring, axillary tightness radiating into the upper arm, lateral chest wall and posterior tightness over the teres major muscle.
  
  
  CONCLUSIONS
  Breast cancer treatment results in tissues losing their shearing and gliding ability. Mapped restrictive tissue gliding clearly shows wider than reported restrictions. This pattern needs further research and investigation.
authors.affiliation: willief@medi.co.za
authors.forename: W J
authors.initials: WJ
authors.lastname: Fourie
mesh_terms: D000368:Aged; D001132:Arm; D001943:Breast Neoplasms / Q000601:surgery*; D005205:Fascia / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015411:Mastectomy, Modified Radical / Q000009:adverse effects*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology* / Q000503:physiopathology*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D016059:Range of Motion, Articular; D012785:Shoulder Joint / Q000503:physiopathology