Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement.
BACKGROUND
Shoulder movement impairment is a commonly reported consequence of surgery for breast cancer.


OBJECTIVE
The aim of this study was to determine whether shoulder girdle kinematics, including those of the scapula, spine, and upper limb, in women who have undergone a unilateral mastectomy for breast cancer are different from those demonstrated by an age-matched control group.


METHODS
An observational study using 3-dimensional kinematic analysis was performed.


METHODS
Women who had a unilateral mastectomy on their dominant-arm side (n=29, mean [+/-SD] age=62.4+/-8.9 years) or nondominant-arm side (n=24, mean [+/-SD] age=59.8+/-9.9 years), as well as a control group of age-matched women without upper-limb, shoulder, or spinal problems (n=22, mean [+/-SD] age=58.1+/-11.5 years), were measured while performing bilateral arm movements in the sagittal, scapular, and coronal planes. All of the women were free of shoulder pain at the time of testing. Data were collected from the glenohumeral joint, the scapulothoracic articulation, and the spine (upper and lower thoracic and lumbar regions) using an electromagnetic tracking system.


RESULTS
Women following mastectomy displayed altered patterns of scapular rotation compared with controls in all planes of movement. In particular, the scapula on the mastectomy side rotated upward to a markedly greater extent than that on the nonmastectomy side, and women following mastectomy displayed greater scapular excursion than controls.


CONCLUSIONS
The findings suggest that altered motor patterns of the scapula are associated with mastectomy on the same side. Whether these changes are harmful or not is unclear. Investigation of interventions designed to restore normal scapulohumeral relationships on the affected side following unilateral mastectomy for breast cancer is warranted.
Clinical Rehabilitation Sciences Research Group, Discipline of Physiotherapy, Faculty of Health Sciences, University of Sydney, PO Box 170, East Street, Lidcombe, New South Wales 1825, Australia. J.Crosbie@usyd.edu.au
Jack
J
Crosbie
Sharon L
SL
Kilbreath
Elizabeth
E
Dylke
Kathryn M
KM
Refshauge
Leslie L
LL
Nicholson
Jane M
JM
Beith
Andrew J
AJ
Spillane
Kate
K
White
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D001943:Breast Neoplasms / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D012399:Rotation; D012540:Scapula / Q000503:physiopathology*; D012785:Shoulder Joint / Q000503:physiopathology*; D013131:Spine / Q000503:physiopathology*