Breast cancer is the most common occurring cancer among women in Singapore. Every year, over 2000 women are diagnosed with breast cancer. Unfortunately, cancer is not the only thing one who experiences breast cancer might deal with. There are many side effects of breast cancer, and shoulder pain is one of them. You must be wondering – what does breast cancer have anything to do with shoulder pain? You’d be surprised to find out that many women experience shoulder issues after breast cancer treatment.
Why do some people experience shoulder pain after a mastectomy?
To understand how the shoulder is relevant to breast cancer, we first need to understand what a mastectomy is and how it is performed.
What is a mastectomy?
A mastectomy is the removal of the whole breast. It is often performed to remove cancerous tissue around the breast, in order to prevent the cancerous cells from growing and spreading to other regions. In some cases, a modified radical mastectomy, or a radical mastectomy might be performed. These surgeries involve the removal of both breast tissue and lymph nodes.
Lymph nodes are small bean-shaped structures, part of the body’s immune system, that transport lymphatic fluid around the body (think of it as the circulatory system for your body’s immune system). They may be removed for further examination to determine if the cancer cells have spread beyond the breast.
The table below summarizes what happens in the various types of mastectomy:
Why do some people experience shoulder pain?
Shoulder pain most commonly occurs with women whose lymph nodes have been removed. This is because these lymph nodes reside at the underarm area, which is of close proximity to the shoulder.
After a mastectomy, some people might present with reduced shoulder range of motion, causing maladaptive movements. These movements can lead to secondary shoulder issues and pain. Arm swelling (lymphoedema) and underarm cording (due to the scarring of tissues under the arm) are two major causes for reduced ranges of movements post-mastectomy.
Scar formation from the surgical site, and protective postures could also contribute to the development of shoulder pain. It was found that scar formation and protective postures cause a shortening of the chest muscles (pectorals). This may cause changes in the shoulder position, resulting in misalignment and an altered relationship between the shoulder blade and arm bone. These structural changes can become chronic and eventually cause pain in the shoulder.
Given that, it is important for us to identify any early onset of the above factors that could cause shoulder pain and address them as soon as possible.
What can I do to address the pain in my shoulder?
A supervised program which consists of stretching and strengthening exercises has shown to reduce pain and improve shoulder range and function.
As post-mastectomy shoulder pain can arise from various factors, our Physiotherapists will help to assess your shoulder and come up with a targeted program addressing specific impairments. Depending on your presentation, manual therapy may be done in conjunction with prescribed exercises, to help with your swelling or range of motion deficits. Manual therapy techniques may include scar tissue massage, soft tissue massage or stretching.
You may start off with simple stretches, together with strengthening exercises using elastic bands. Stretching and strengthening through range is important for functional movements (e.g. reaching up for something on a shelf, washing your hair or dressing yourself). These exercises can be progressed to movements that require more control and coordinated muscular activity. Given the complexity of cancer treatment, our Physiotherapists are equipped with the skills and knowledge to manage any other cancer related issues such as fatigue and are able to tailor the program appropriately.
Some exercises you can expect may include:
Tricep stretch
Shoulder wall stretch
Banded shoulder wall climbs
Banded draw the sword
Banded shoulder flexion
Banded bow and arrow
Scaption
Medicine ball wood chop
Book now or give us a call to schedule an appointment to see our Physiotherapist who will be able to partner you to recovery as we address your shoulder pain!
DISCLAIMER: These advice and exercises should not replace the need for a consultation with a Physiotherapist especially if your condition doesn’t improve. Therapeutic exercise should be carefully selected to suit your condition.
References
Crosbie, J., Kilbreath, S., Dylke, E., Refshauge, K., Nicholson, L., & Beith, J. et al. (2010). Effects of Mastectomy on Shoulder and Spinal Kinematics During Bilateral Upper-Limb Movement. Physical Therapy, 90(5), 679-692. https://doi.org/10.2522/ptj.20090104
Giacalone, A., Alessandria, P., & Ruberti, E. (2019). The Physiotherapy Intervention for Shoulder Pain in Patients Treated for Breast Cancer: Systematic Review. Cureus, 11(12), e6416. https://doi.org/10.7759/cureus.6416
Managing Upper Extremity Dysfunction in Breast Cancer Survivors – The ASCO Post. Ascopost.com. (2021). Retrieved 26 October 2021, from https://ascopost.com/issues/july-10-2016/managing-upper-extremity-dysfunction-in-breast-cancer-survivors/.
What Is Mastectomy?. Breastcancer.org. (2021). Retrieved 26 October 2021, from https://www.breastcancer.org/treatment/surgery/mastectomy/what_is.
Filed under: Cancer
