Scapular Dyskinesia After Modified Radical Mastectomy Surgery and Breast Conserving Surgery.

Abstract

Objectives: The pectoralis minor muscle is negatively affected by mastectomy surgery, and this negative effect may be broken scapular kinematics. Aimed of this study was to evaluate present of the scapular dyskinesia (SD) in Modified Radical Mastectomy Surgery (MRMS) and Breast Conserving Surgery (BCS). Materials and Methods: Forty patients who had MRMS or BCS participated in the present study. Pain, SD, and upper extremity disabilities were evaluated. Results: There were no differences in age, body mass index, pain, upper extremity disabilities, Lateral Scapular Slide Test (LSST), and Scapular Assistance Test (SAT) between BCS and MRMS (p>0.05). But there was a difference in Scapular Retraction Test (SRT) (p:0.024). The number of patients who had SD was higher in BCS. There was no relationship between SD and other parameters (p>0.05) in both surgeries. There was a moderate negative correlation between pain and SRT/SAT in MRMS (r:-0.564; p:0.01 and r:-0.564; p:0.01, respectively) while there was no correlation between pain and SRT/SAT in BCS (p>0.05). Conclusion: The present study showed that SD should be seen after mastectomy surgery, especially in BCS. Assessment of the presence of SD and training of scapular muscles was thought necessary before/after mastectomy. Although survival is a critical issue, teaching preventive/corrector exercises may be important for patient's quality of life after surgery.

Keywords

• Pectoralis Minor
• Scapular Dyskinesia
• Breast Cancer
• Modified Radical Mastectomy Surgery
• Breast-Conserving Surgery

References

1. Adriaenssens, N., De Ridder, M., Lievens, P., Van Parijs, H., Vanhoeij, M., Miedema, G., et al. (2012). Scapula alata in early breast cancer patients enrolled in a randomized clinical trial of post-surgery short-course image-guided radiotherapy. World J Surg Oncol, 16(10), 86.
2. Akça, M., Ata, A., Nayır, E., Erdoğdu, S., &Arıcan, A. (2014). Impact of Surgery Type on Quality of Life in Breast Cancer Patients. J Breast Health, 10(4), 222–228.
3. Crosbie, J., Kilbreath, S. L., Dylke, E., Refshauge, K. M., Nicholson, L. L., Beith, J. M., et al. (2010). Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement. Phys Ther, 90(5), 679-92. doi: 10.2522/ptj.20090104.
4. Czajka, M. L., Pfeifer, C. (2020). Breast Cancer Surgery. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK553076/
5. Dumont, D. J., Jussila, L., Taipale, J., Lymboussaki, A., Mustonen, T., &Pajusola, K. (1988). Cardiovascular failure in mouse embryos deficient in VEGF receptor-3. Science, 282(5390), 946-949.
6. Düger, T., Yakut, E., Öksüz, Ç., Yörükan, S., Bilgütay, B., &Ayhan, Ç. (2006). Reliability and validity of the Turkish version of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. Turkish J of Physiother and Rehab, 17(3), 99-107.
7. Ebaugh, D., Spinelli, B., &Schmitz, K. H. (2011). Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. Med Hypotheses, 77(4), 481-487.
8. Hudak, P. L., Amadio, P. C., &Bombardier, C. (1996). The Upper Extremity Collaborative Group (UECG) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Ind Med, 29, 602–608.

9. Illyés, A., &Kiss, R. M. (2006). Kinematic and muscle activity characteristics of multidirectional shoulder joint instability during elevation. Knee Surg Sports Traumatol Arthrosc, 14, 673–685.
10. Itoi, E., Kido, T., Sano, A., Urayama, M., &Sato, K. (1999). Which is more useful, the “full can test” or the “empty can test,” in detecting the torn supra-spinatus tendon? The American Journal of Sports Medicine, 27(1), 65-68.
11. Khorana, A. A. (2009). Cancer and thrombosis: Implications of published guidelines for clinical practice. Annals of Oncology, 20(10), 1619-1630.
12. Kibler, W. B. (1998). The role of the scapular in athletic shoulder function. American Journal of Sports Medicine, 27(2), 801-805.
13. Kibler, W. B., &Sciascia, A. (2010). Current Concepts: Scapular Dyskinesia. British Journal Of Sports Medicine, 44(5), 300–305.
14. Kibler, W. B., Sciascia, A., &Dome, D. (2006). Evaluation of apparent and absolute supraspinatus strength in patients with shoulder injury using the scapular retraction test. Am J Sports Med, 34, 1643–1647.
15. Macdonald, L., Bruce, J., Scott, N. W., Smith, W. C., &Chambers, W. A. (2005). Longterm follow-up of breast cancer survivors with post-mastectomy pain syndrome. British Journal of Cancer, 92(2), 225-230.
16. Marazzi, F., Masiello, V., Marchesano, D., Boldrini, L., Luzi, S., Ferrara, P. E., et al. (2019). Shoulder girdle impairment in breast cancer survivors: the role of range of motion as predictive factor for dose distribution and clinical outcome. Tumori, 105(4), 319-330.
17. McClure, P. W., Michener, L. A., Sennett, B. J., &Karduna, A. R. (2001). Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg, 10, 269-77.
18. McNeely, M. L., Binkley, J. M., Pusic, A. L., Campbell, K. L., Gabram, S., &Soballe, P. W. A. (2012). Prospective model of care for breast cancer rehabilitation: Postoperative and postreconstructive issues. Cancer, 11(suppl 8), 2226-2236.
19. Morais, N., &Cruz, J. (2016). The pectoralis minor muscle and shoulder movement-related impairments and pain: Rationale, assessment and management. Phys Ther Sport, 17, 1–13.
20. Provencher, M., Golijanin, P., Gross, D., Campbell, K. J., Gaston, T., &Anthony, S. (2014). Isolated Pectoralis Minor Release for Scapular Dyskinesia. Orthop J Sports Med, 2(2Suppl), doi:10.1177/2325967114S00097.
21. Ribeiro, I. L., Camargo, P. R., Alburquerque-Sendín, F., Ferrari, A. V., Arrais, C. L., &Salvini, T. F. (2019). Three-dimensional scapular kinematics, shoulder outcome measures and quality of life following treatment for breast cancer - A case control study. Musculoskelet Sci Pract, 40, 72-79.
22. Roche, S. J., Funk, L., Sciascia, A., Kibler, W. B. (2015). Scapular dyskinesia: the surgeon's perspective. Shoulder Elbow, 7(4), 289-297.
23. Serlin, R. C., Mendoza, T. R., Nakamura, Y., Edwards, K. R., &Cleeland, C. S. (1995). When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain, 61, 277-284.
24. Shamley, D. R., Srinaganathan, R., Weatherall, R., Oskrochi, R., Watson, M., Ostlere, S., et al. (2007). Changes in muscle size and activity following treatment for breast cancer. Br Cancer Res Treatment, 106, 19–27.
25. Shamley, D., Srinaganathan, R., Oskrochi, R., Lascurain-Aquirrebeña, I., &Sugden, E. (2009). Three-dimensional scapulothoracic motion following treatment for breast cancer. Breast Cancer Research and Treatment, 118(2), 315-322.
26. Shimoji, K., Aida, S. (2020). Pain Measurements. In: Shimoji, K., Nader, A., Hamann, W. (Eds) Chronic Pain Management in General and Hospital Practice (pp:173-200). Springer, Singapore. Online ISBN:978-981-15-2933-7.
27. Staradub, V. L., Morrow. M. (2002). Modified radical mastectomy with knife technique. Arch Surg, 137(1), 105-110. doi:10.1001/archsurg.137.1.105
28. Tasmuth, T., Smitten, K., Hietanen, P., Kataja, M., &Kalso, E. (1995). Pain and other symptoms after different treatment modalities of breast cancer. Annals of Oncology, 6(5), 453–459.