Monday, August 15, 2022

Is Shoulder Pain Related To Breast Cancer

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Postsurgery Treatments And Exercises To Try

Breast Cancer Rehabilitation- Shoulder Pain After Mastectomy

After surgery, its not uncommon to experience symptoms such as swelling, pain, and stiffness.

If you do experience these symptoms, its best to first seek an evaluation from an orthopedic specialist or a physical therapist. They can teach you how to move and exercise safely.

If you arent injured, you can usually proceed with starting an exercise program. You may not feel up to doing very much, but its important to move when you can.

At this stage, even gentle range-of-motion exercises can help keep you from losing too much mobility and prevent you from developing lymphedema.

Shoulder Pain And Breast Cancer

Q: I am a breast cancer survivor who had a mastectomy, chemotherapy, and radiation therapy. The shoulder on my affected side hurts, especially at night or when I lift my arm overhead. What might be the problem, and how should I address this?

Shoulder problems are very common after treatments for breast cancer such problems are normally not a sign that your cancer has returned or spread. Up to 68% of patients with breast cancer experience shoulder pain and/or restricted motion of the shoulder during or after treatment this problem can result from 1 of 2 common causes.

Nerve Damage And Dysesthesia

The nerves that control our hands and fingers go down our arms and travel through the axilla. If these are damaged by surgery or radiation, the result is pain. This common nerve pain feels like sudden, intense, stabbing pain in your underarm, arm, or even hands. It lasts only moments, but is erratic and unpredictable. As the nerves begin to heal from surgery, there can be a resurgence of this pain. The medical term for this type of pain is called dysesthesia.

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What Does Shoulder Blade Pain Feel Like When Its Related To Breast Cancer

The type of pain you feel usually depends on whats causing it. Some people have shoulder pain due to nerve damage from radiation therapy or a lumpectomy, mastectomy, or lymph node removal.

If you have neuropathic pain, you may feel a shooting or burning sensation. Some people describe the discomfort as an intense tingling or itching feeling.

You might also experience sharp pain when you try to move your arms up or down. This pain can be accompanied by swelling, stiffness, or numbness.

If your pain is caused by cancer that has spread , it might feel like a deep, dull ache in your joints or bones. Pain near your right shoulder blade could mean that your liver is involved.

You may also feel depressed or anxious, and your sleep may be disrupted as a result of your pain. Not getting enough sleep may make your pain feel even worse.

Your shoulder is a complex, interconnected group of bones, muscles, ligaments, tendons, nerves, and blood vessels. These structures work together to align your posture and help you move your arms.

Your scapula serves several important functions:

  • It cups the ball-shaped end of the humerus bone in your upper arm.
  • It serves as an attachment plate for several muscles and ligaments.
  • It moves in several directions as you use your arms, providing stability and flexibility.

Other treatments damage the nerves around your shoulder blade, causing long-lasting pain in your shoulders, arms, hands, and feet.

Exercise And Physical Therapy

Lung cancer and shoulder pain: What

If possible, it can be very helpful to meet with a physical therapist before breast cancer surgery or radiation. There are exercises to do in advance that may reduce the risk of future problems. If it is too late for that, it would still be useful to meet with a physical therapist who can design a personal program to reduce shoulder mobility issues or pain. At BIDMC, we have clinicians who are trained and experienced to work with breast cancer patients with mobility issues. Learn more about BIDMC’s Physical Therapy Services.

Oncologic Physical Therapy

There is a new national certification for physical therapists who have completed training and have experience working with cancer patients and survivors. It is called Board-Certified Clinical Specialist in Oncologic Physical Therapy. If you are seeking a good PT to help with your recovery, ask if s/he has this certification.

Have you experienced shoulder issues after breast cancer surgery? Join the BIDMC Cancer Community and share your story.

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Treatment Related Impairments In Arm And Shoulder In Patients With Breast Cancer: A Systematic Review

  • * E-mail:

    Affiliations Radboud university medical center, Department of Orthopedics, Section of Physical Therapy, Nijmegen, The Netherlands, Radboud university medical center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands

  • Affiliation Radboud university medical center, Department of Orthopedics, Section of Physical Therapy, Nijmegen, The Netherlands

  • Affiliation Radboud university medical center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands

  • Affiliation Academic Medical Center, Department of Medical Oncology, University of Amsterdam, Amsterdam, The Netherlands

  • Affiliation Radboud university medical center, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands

Arm/shoulder Problems Common After Breast Cancer Surgery

A study found that most women who had breast cancer surgery had some type of arm problem even 1 1/2 years after surgery. The research was presented at the 2008 American Society of Clinical Oncology Breast Cancer Symposium.

After breast cancer surgery, some women experience numbness, swelling, weakness, or tingling in the arm and shoulder area on the same side of the body on which surgery was done. These problems are more likely to happen after mastectomy surgery and less likely to happen after lumpectomy. The possibility for arm and shoulder problems depends quite a bit on whether any lymph nodes were removed during surgery and if so, how many were removed.

The researchers studied more 250 women for 18 months after breast cancer surgery. Every 3 months, the women reported any arm problems and had a physical exam to check for any movement or function problems. The researchers tested upper body strength and endurance, hand grip, flexibility, and range of motion.

The results:

  • Most women with arm problems had more than one symptom.
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    How Exercise Physiology Can Help

    Now I must admit, before studying Exercise Physiology, as an Osteopath we dont learn through university the complexity and processes that occur for women with breast cancer , what medical treatment is like, the outcomes of the treatment not only physically, but the psychosocial aspects of diagnosis and treatment, and then recovery time needed after treatment. However, having gone back to study and learning everything from diagnosis to survival as an Exercise Physiologist, I have been able to take a step back and think, there is also a really good place for Osteopaths to help in the recovery from breast cancer treatment. I have a much greater appreciation and understanding now of why shoulder pain and dysfunction is so prominent in women after surgery and treatment.

    As an Osteopath given our holistic approach to treatment we focus on the shoulders function and movement, but also look at the areas that will also be affected by shoulder pain, such as the neck, upper back and sometimes lower back. During the session we use lots of different treatment techniques to help relieve pain and improve movement of the affected shoulder region. The manual treatment provided is important to aid with pain relief and improve movement, but it is only half of the story when it comes to recovery of shoulder function. A tailored and specific exercise rehab program is also needed to help strengthen the shoulder.

    • Reduce pain

    Upper Extremity Dysfunction In Cancer Survivors

    Post-Surgery Shoulder Care – Westmead Breast Cancer Institute
    • Upper extremity impairments affect a great number of cancer survivors. Early recognition and involvement from a rehabilitation team may result in better outcomes.
    • Proper diagnosis of upper extremity dysfunction is essential for successful treatment and for patients understanding of the etiology of dysfunction to prevent further complications.
    • Physiatric consultation should be considered in complex cases and in all cases in which physical or occupational therapy alone is insufficient.

    Rarely, extension of cancer to the axilla or a larger field of radiation may result in brachial plexopathy. Depending on the case, brachial plexopathy could present as severe pain and/or diffused weakness of the arm it tends to occur years after radiation and is becoming increasingly uncommon.

    Diagnosis and Treatment of Shoulder/Arm Problems

    Physiatrists have a vast knowledge of neuromusculoskeletal conditions and should aid in both the diagnosis and treatment of upper extremity dysfunction. Education about symptom management and simple exercises before initiation of treatments is an effective and simple way to prevent upper extremity dysfunction. It is believed that a supervised program consisting of stretching and strengthening exercises can reduce pain and improve shoulder range of motion and function.

    Sean Smith, MD

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    A Family History Of Breast Cancer

    For Tamika, fear was the worst part of cancer. Her mother had breast cancer and a mastectomy. Her sister also had breast cancer but decided against chemotherapy or radiation. By the time she changed her mind and wanted treatment, there was nothing doctors could do, says Tamika.

    When Tamika learned that her mother, who lives in Memphis, had cancer again, she wanted to care for her. Instead, she sent her daughter and made video calls while continuing her own treatment in Detroit.

    I did the last radiation treatments by myself, but I still had the staff at Henry Ford. They made sure I didnt feel like I was alone, says Tamika. They were right there as if they were family.

    Her friends also helped. They kept me normal. Everything we talked about was not cancer, she says.

    My son, daughter, and daughter-in law never let me down. Weve had our moments, but we didnt let the cancer consume us. Theyd tell me to say I was going to beat cancer and keep saying it.

    Between my kids and my two grandkids, I had no other choice but to get through this. They need to remember their grandmom, says Tamika.

    These days, Tamika is promoting early detection of cancer. Ive been yelling, screaming, and shouting for women to get a mammogram and ultrasound if possible, she says. The earlier you detect it, the better you are.

    Next on Tamikas agenda? Be with the grandkids. Enjoy life. And even do something extra shes working to help to create housing for homeless veterans.

    Breast Cancer Awareness: Shoulder Pain

    Breast cancer is the most common cancer among women in the United States . But millions of women are surviving the disease thanks in part to early detection and improvements in treatment.

    Shoulder pain in breast cancer survivors is a common condition that should not be ignored. Early detection and treatment are important in preventing long-term complications.

    Dr. Eric M. Wisotzsky is the Chief of Rehabilitation Medicine and Director of the Cancer Rehabilitation Program at MedStar National Rehabilitation Health Networks. He is also an Assistant Professor of Rehabilitation at Georgetown University Medical Center.

    Many breast cancer survivors who have had surgery, chemotherapy and radiation report shoulder pain especially when lifting their arm overhead. What might be the problem?

    Shoulder problems are extremely common after breast cancer treatment. Up to 68% of breast cancer patients may experience shoulder pain and/or restricted shoulder motion. There are two common causes of these symptoms.

  • Frozen Shoulder
  • This condition involves a very stiff shoulder which may or may not be painful. Not moving the arm enough after breast cancer treatment can sometimes lead to this problem. In addition, radiation can add to this stiffness.
  • In terms of treating this problem, seeing a physician who can correctly diagnose the problem is the critical first step.
  • The physiatrist will talk to you and examine your shoulder to determine the cause of pain.
  • What if physical therapy doesnt help?

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    By Step Guide On How To Perform Breast Self Exam At Home:

    Look at your breasts in the mirror Position your shoulders straight and place your arms on your hips. See if your breasts have their usual size, shape, color and whether they have visible swelling or change in shape. Check that they dont have dimpling or puckering of the skin, or that they became red, sore, swollen or have rash. Also check your nipples to see if they became inverted or changed their position.

    Raise your arms and look for the same changes. Squeeze the nipple and check if fluid comes out of one or both nipples. The discharge can be a watery, milky, or yellow fluid or blood.

    Check your breast when lying down Use your right hand to feel your left breast and then vice versa. When feeling your breast with your hands, keep your fingers together and use the first few finger pads applying small circular motions covering the entire breast area and armpit.

    Check yourself in the shower Many women find that it is easier to check for changes in the breast when their hands are wet and slippery with soap and water. Cover your entire breast, using the same hand movements as when lying down and check for any lumps or thickening in your underarm area too.

    If you find something suspicious with your breast dont panic, as most of the lumps are not cancerous and many breast changes are not associated with cancer, but for your own peace of mind call your doctor if you have any concerns.

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    Mapping Of The Frontal Region Of The Shoulder

    Lung Cancer and Shoulder Pain: Are They Related?

    The acromion was used as the reference point to start designing the grid on the deltoid muscle. Point 1 was marked below the acromion at one-twelfth of the distance d . Thereafter, three points downwards vertically separated by one-sixth of the distance d were marked and labeled point 2, 3, and 4. Points 5 and 6 were symmetrically allocated at one-sixth of the distance d medial to points 3 and 4, respectively . The coracoid bone was the reference point for drawing the grid on the pectoralis major muscle. Point 9 was marked below the coracoid at one-twelfth of the distance d . Thereafter, three points downwards vertically separated by one-sixth of the distance d were marked and labeled point 10, 11, and 12. Points 7 and 8 were symmetrically located at one-sixth of the distance d external to points 10 and 11, respectively. The pressure pain maps were generated based on the mean PPTs using Matlab . The x and y coordinates of each point were measured for one representative participant . The z coordinates corresponded to the average 27 PPT points of the 22 participants. An inverse distance weighted interpolation was applied to obtain the PPT distribution over the shoulder region . This method enables the detection of spatial differences in the pressure sensitivity of the deep structures .

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    Breast Cancer And Its Relationship To Shoulder Pain

    Breast cancer is the leading cancer diagnosis in women in Australia. Through my 5 years as an Osteopath and just starting as an Exercise Physiologist, I have seen many women who come to see me with shoulder pain and dysfunction after breast cancer treatment.

    Pain through the shoulder is very common after surgery, whether a lumpectomy, mastectomy and/or reconstruction is performed along with possibly having lymph node biopsy and/or clearance. The time spent during surgical procedures with your arm left in a position so that the area is exposed for the surgeon, then afterwards leaving the arm down and resting to allow healing of surgical incisions, and the formation of scar tissue leads to restricted shoulder range of motion and pain with movement.

    It is very important for women after clearance from the surgeon to be assessed by an allied health professional such as an Osteopath or Exercise Physiologist, to help kick start recovery and get education on appropriate rehabilitation of the shoulder girdle.

    Breast Pain Not Linked To Periods

    Its often unclear what causes non-cyclical breast pain.

    It can be related to:

    • a benign breast condition
    • previous surgery to the breast
    • injury to the breast
    • having larger breasts
    • a side effect from a drug treatment, such as certain antidepressant drugs and some herbal remedies such as ginseng

    Stress and anxiety can also be linked to breast pain.

    Non-cyclical breast pain may be continuous or it may come and go. It can affect women before and after the menopause.

    The pain can be in one or both breasts and can affect the whole breast or a specific area. It may be a burning, prickling or stabbing pain, or a feeling of tightness.

    Non-cyclical breast pain often goes away by itself over time. This happens in about half the women who experience it.

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    Why Do My Breasts Hurt

    Breast pain is very common in women of all ages.

    Having painful, sore or tender breasts can cause a lot of anxiety. But on its own, pain in the breasts isn’t usually a sign of breast cancer.

    Many women experience breast pain as part of their normal menstrual cycle . This is called cyclical breast pain.

    Lasting pain in the breast thats not related to periods is known as non-cyclical breast pain.

    Sometimes pain that feels as though it’s in the breast is coming from somewhere else, such as a pulled muscle in the chest. This is known as chest wall pain.

    The Influence Of Arm Swelling Duration On Shoulder Pathology In Breast Cancer Patients With Lymphedema

    Shoulder Exercises after Breast/Oral Cancer Surgery by Dr Vipin Goel
    • Affiliation Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

    • Affiliation Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

    • Affiliation Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

    • * E-mail:

      Affiliation Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

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