title: Development of active myofascial trigger points in neck and shoulder musculature is similar after lumpectomy or mastectomy surgery for breast cancer.
abstract: Our aim was to describe the differences in the presence of myofascial trigger points (TrPs) in neck and shoulder muscles after 2 surgery approaches for breast cancer: mastectomy or lumpectomy. Thirty-two women (mean age: 50 ± 7 years) who received lumpectomy, 16 women (mean age: 48 ± 10 years) who had received mastectomy after breast cancer, and 16 women (mean age: 49 ± 9 years) with breast cancer who had not received either surgical treatment, participated. Myofascial TrPs in the upper trapezius, sternocleidomastoid, levator scapulae, scalene, infraspinatus and pectoralis major muscles were bilaterally explored by an assessor blinded to the women's condition. TrPs were considered active when palpation reproduced local and referred pain symptoms recognized by the patient as familiar pain symptoms. The number of active TrPs within mastectomy (mean ± SD: 4.6 ± 1) and lumpectomy (mean ± SD: 4.5 ± 1) groups was significantly higher (P < 0.001) as compared to the control group (mean ± SD: 1.1 ± 1.3), but not significantly different between them (P = 0.641). Women who received either lumpectomy or mastectomy showed similar distribution of active TrPs and a higher prevalence of active TrPs as compared to the control group. Active TrPs in the pectoralis major muscle were the most prevalent in both surgery groups The number of active TrPs was weakly correlated with neck (r(s) = 0.385; P = 0.029) and shoulder/axillary (r(s) = 0.397; P = 0.024) pain intensity within the lumpectomy, but not the mastectomy group. This study found active TrPs in neck and shoulder musculature in women who had received lumpectomy or mastectomy. The induced local and referred pain pattern from active TrPs reproduced neck and shoulder/axillary symptoms and pain patterns in women after breast cancer surgery. Few active TrPs were found in a control group of women with breast cancer who had not received any surgical treatment.
authors.affiliation: Department of Physical Therapy, Universidad Granada, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Fernández-Lao
authors.forename: Irene
authors.initials: I
authors.lastname: Cantarero-Villanueva
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
authors.forename: Rosario
authors.initials: R
authors.lastname: Del-Moral-Ávila
authors.forename: Salomón
authors.initials: S
authors.lastname: Menjón-Beltrán
authors.forename: Manuel
authors.initials: M
authors.lastname: Arroyo-Morales
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D009209:Myofascial Pain Syndromes / Q000209:etiology* / Q000503:physiopathology*; D009334:Neck Muscles / Q000503:physiopathology; D019547:Neck Pain / Q000209:etiology* / Q000503:physiopathology; D010149:Postoperative Pain / Q000209:etiology / Q000503:physiopathology; D053591:Referred Pain / Q000209:etiology / Q000503:physiopathology; D017006:Rotator Cuff / Q000503:physiopathology; D020069:Shoulder Pain / Q000209:etiology* / Q000503:physiopathology