Comparison of Shoulder Kinematics, Flexibility, Strength, and Function between Breast Cancer Survivors and Healthy Participants

The present study compared shoulder kinematics, flexibility, strength, and function between breast cancer survivors and healthy, matched participants. Twenty four breast cancer survivors and twenty four matched controls completed the Disabilities of Arm, Shoulder, and Hand (DASH) and the Pennsylvania Shoulder Score (PSS) outcome measure questionnaires. Clinical measures of shoulder active (AROM) and passive (PROM) range of motion, cervical AROM, and shoulder strength were analyzed. Participants also had scapular kinematics assessed during the elevation phase of three tasks: flexion, scaption, and reaching. The results indicated statistically significant differences with the breast cancer survivors demonstrating decreased scores on the DASH and PSS, decreased AROM and PROM flexion and 90o ER, decreased AROM extension, and decreased strength for the measures of scapula abduction and upward rotation, scapula depression and adduction, shoulder flexion, shoulder adduction, shoulder internal and external rotation, and scaption. Kinematic analysis revealed a main effect for group during the scaption task for protraction/retraction with the breast cancer survivors demonstrating greater protraction throughout arm elevation. Correlation analyses revealed a relationship with the DASH to AROM flexion, PROM flexion and 90o ER, strength measures of scapula abduction and upward rotation, scapula depression and adduction, shoulder flexion, shoulder adduction, shoulder internal, and scaption, and cervical spine AROM left rotation. The PSS was found to correlate with AROM flexion, PROM flexion and 90o ER, strength measures of shoulder flexion, shoulder adduction, shoulder internal, and scaption, and cervical spine AROM left sidebending, left rotation, and right rotation. The results demonstrate the ROM measures of humeral flexion and humeral ER at 90o appear to be affected in the breast cancer survivor population. All seven of the strength measures assessed in this study were found to be decreased in the breast cancer survivor cohort. Finally, increased scapula protraction is another key finding. The results from this study provide preliminary evidence to suggest that clinicians focus on these particular ROM and strength measures when treating a breast cancer survivor who has recently completed their primary treatment. Results from this study also show women who have recently completed their primary breast cancer treatment appear to have function deficits as revealed in this study when using outcome measures such as the DASH and PSS