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Shoulder Kinematics of Axillary Web Syndrome in Women Treated for Breast Cancer

Published:October 03, 2022DOI:https://doi.org/10.1016/j.apmr.2022.09.014

      Highlights

      • Five years after surgery for breast cancer, women diagnosed with axillary web syndrome (AWS) have altered scapulohumeral kinematics that may place them at increased risk of shoulder pain and rotator cuff disease.
      • Women with AWS demonstrated less scapular upward rotation at 120° of arm elevation (P=.005), regardless of plane.
      • A better understanding of shoulder kinematics after breast cancer treatment could lead to specific and effective rehabilitation programs for cancer survivors with shoulder pain.

      Abstract

      Objective

      To better understand how the shoulder moves in breast cancer survivors with axillary web syndrome (AWS), we compared 3-dimensional (3D) shoulder kinematics during shoulder elevation among breast cancer survivors with and without AWS 5 years postoperatively. Although research consistently shows decreased shoulder range of motion with AWS, we do not understand the underlying biomechanics.

      Design

      Nested case control study.

      Setting

      University Academic Breast Center.

      Participants

      Twenty-five women who had surgery 5 years previously for unilateral breast cancer with the removal of at least 1 lymph node participated in this study (N=25). Twelve participants had AWS; 13 women did not have AWS.

      Interventions

      Not applicable.

      Main Outcome Measures

      Three-dimensional shoulder kinematic data during shoulder forward flexion, scapular plane abduction, and coronal plane abduction were collected using 3D electromagnetic motion tracking. Kinematic data were extracted at 30°, 60°, 90°, and 120° of arm elevation for scapular upward rotation, internal rotation, and posterior tilt as well as for glenohumeral external rotation.

      Results

      Women with AWS demonstrated 15.2° less scapular upward rotation at 120° humerothoracic elevation (95% confidence interval [-25.2, -5.2], P=.005), regardless of plane. No significant between-group differences were found for any other angle of scapular upward rotation, nor for scapular internal rotation, scapular posterior tilt, or glenohumeral axial rotation at any angle.

      Conclusions

      Five years after surgery for breast cancer, women diagnosed with AWS have altered scapulohumeral kinematics that may place them at an increased risk of shoulder pain based on existing kinematic literature in healthy cohorts. This information can help guide rehabilitation programs for breast cancer survivors to facilitate pain-free upper extremity function after treatment.

      Keywords

      List of abbreviations:

      AWS (axillary web syndrome), ROM (range of motion), 3D (3-dimensional), STur (scapulothoracic upward rotation)
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      References

        • Boquiren VM
        • Hack TF
        • Thomas RL
        • et al.
        A longitudinal analysis of chronic arm morbidity following breast cancer surgery.
        Breast Cancer Res Treat. 2016; 157: 413-425
        • Rietman JS
        • Geertzen JHB
        • Hoekstra HJ
        • et al.
        Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer.
        Eur J Surg Oncol. 2006; 32: 148-152
        • Chrischilles EA
        • Riley D
        • Letuchy E
        • et al.
        Upper extremity disability and quality of life after breast cancer treatment in the Greater Plains Collaborative clinical research network.
        Breast Cancer Res Treat. 2019; 175: 675-689
        • Koehler LA
        • Hunter DW
        • Blaes AH
        • Haddad TC.
        Function, shoulder motion, pain, and lymphedema in breast cancer with and without axillary web syndrome: an 18-month follow-up.
        Phys Ther. 2018; 98: 518-527
        • Leidenius M
        • Leppanen E
        • Krogerus L
        • von Smitten K.
        Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer.
        Am J Surg. 2003; 185: 127-130
        • Leduc O
        • Fumière E
        • Banse S
        • et al.
        Identification and description of the axillary web syndrome (AWS) by clinical signs, MRI, and US Imaging.
        Lymphology. 2014; 47: 164-176
        • Moskovitz AH
        • Anderson BO
        • Yeung RS
        • Byrd DR
        • Lawton TJ
        • Moe RE.
        Axillary web syndrome after axillary dissection.
        Am J Surg. 2001; 181: 434-439
        • Koehler LA
        • Blaes AH
        • Haddad TC
        • Hunter DW
        • Hirsch AT
        • Ludewig PM.
        Movement, function, pain, and postoperative edema in axillary web syndrome.
        Phys Ther. 2015; 95: 1345-1353
        • Koehler LA
        • Haddad TC
        • Hunter DW
        • Tuttle TM.
        Axillary web syndrome following breast cancer surgery: symptoms, complications, and management strategies.
        Breast Cancer Targets Ther. 2019; 11: 13-19
        • Koehler LA
        • Hunter DW
        • Haddad TC
        • Blaes AH
        • Hirsch AT
        • Ludewig PM.
        Characterizing axillary web syndrome: ultrasonographic efficacy.
        Lymphology. 2014; 47: 156-163
        • Koehler L
        • Day A
        • Hunter D
        • Blaes A
        • Haddad T
        • Shanley R.
        Five-year cumulative incidence of axillary web syndrome and comparison in upper extremity movement, function, pain, and lymphedema in survivors of breast cancer with and without axillary web syndrome.
        Arch Phys Med Rehabil. 2022; : 1-9
        • Crosbie J
        • Kilbreath SL
        • Dylke E
        • et al.
        Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement.
        Phys Ther. 2010; 90: 679-692
        • Rundquist PJ
        • Behrens BA
        • Happel AS
        • Kennedy K
        • Biggers L
        Shoulder kinematics and function in breast cancer survivors with unilateral lymphedema: an observational study.
        Rehab Onc. 2015; 33: 41-46
        • Shamley D
        • Lascurain-Aguirrebeña I
        • Oskrochi R
        • Srinaganathan R.
        Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy.
        Acta Oncol (Madr). 2012; 51: 1045-1053
        • Borstad JD
        • Szucs KA.
        Three-dimensional scapula kinematics and shoulder function examined before and after surgical treatment for breast cancer.
        Hum Mov Sci. 2012; 31: 408-418
        • Ribeiro IL
        • Camargo PR
        • Alburquerque-Sendín F
        • Ferrari AV
        • Arrais CL
        • Salvini TF.
        Three-dimensional scapular kinematics, shoulder outcome measures and quality of life following treatment for breast cancer—a case control study.
        Musculoskelet Sci Pract. 2019; 40: 72-79
        • Spinelli BA
        • Silfies S
        • Jacobs LA
        • Brooks AD
        • Ebaugh D.
        Scapulothoracic and glenohumeral motions during functional reaching tasks in women with a history of breast cancer and healthy age-matched controls.
        Rehabil Oncol. 2016; 34: 127-136
        • Fisher B
        • Fisher ER
        • Anderson S
        • et al.
        Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer.
        N Engl J Med. 2002; 347: 1233-1241
        • Levangie PK
        • Drouin J.
        Magnitude of late effects of breast cancer treatments on shoulder function: a systematic review.
        Breast Cancer Res Treat. 2009; 116: 1-15
        • Lee TS
        • Kilbreath SL
        • Refshauge KM
        • Pendlebury SC
        • Beith JM
        • Lee MJ.
        Quality of life of women treated with radiotherapy for breast cancer.
        Support Care Cancer. 2008; 16: 399-405
        • Ludewig PM
        • Cook TM.
        Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement.
        Phys Ther. 2000; 80: 276-291
        • Ludewig PM
        • Reynolds J.
        The association of scapular kinematics and glenohumeral joint pathologies.
        J Orthop Sport Phys Ther. 2009; 39: 90-104
        • Lawrence RL
        • Braman JP
        • Laprade RF
        • Ludewig PM.
        Comparison of 3-dimensional shoulder complex kinematics in individuals with and without shoulder pain, part 1: sternoclavicular, acromioclavicular, and scapulothoracic joints.
        J Orthop Sports Phys Ther. 2014; 44: 636-645
        • McClure PW
        • Michener LA
        • Karduna AR.
        Shoulder function and 3-dimensional scapular kinematics in people with and without shoulder impingement syndrome.
        Phys Ther. 2006; 86: 1075-1090
        • Lukasiewicz AC
        • McClure P
        • Michener L
        • Pratt N
        • Sennett B.
        Comparison of 3-dimensional scapular position and orientation between subjects with and without shoulder impingement.
        J Orthop Sports Phys Ther. 1999; 29: 574-586
        • Sousa C de O
        • Camargo PR
        • Ribeiro IL
        • Reiff RB de M
        • Michener LA
        • Salvini TF.
        Motion of the shoulder complex in individuals with isolated acromioclavicular osteoarthritis and associated with rotator cuff dysfunction: Part 1—three-dimensional shoulder kinematics.
        J Electromyogr Kinesiol. 2014; 24: 520-530
        • Harris PA
        • Taylor R
        • Thielke R
        • Payne J
        • Gonzalez N
        • Conde JG.
        Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Harris PA
        • Taylor R
        • Minor BL
        • et al.
        The REDCap consortium: building an international community of software platform partners.
        J Biomed Inform. 2019; 95103208
      1. Polhemus. Fastrack 3D digitizer & quad sensor motion tracker:1-2. Available at: https://polhemus.com/_assets/img/FASTRAK_Brochure_1.pdf. Accessed February 5, 2021.

        • Karduna AR
        • McClure PW
        • Michener LA
        • Sennett B.
        Dynamic measurements of three-dimensional scapular kinematics: a validation study.
        J Biomech Eng. 2001; 123: 184-190
        • Hamming D
        • Braman JP
        • Phadke V
        • LaPrade RF
        • Ludewig PM.
        The accuracy of measuring glenohumeral motion with a surface humeral cuff.
        J Biomech. 2012; 45: 1161-1168
        • Wu G
        • Van Der Helm FCT
        • Veeger HEJ
        • et al.
        ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion— Part II: shoulder, elbow, wrist and hand.
        J Biomech. 2005; 38: 981-992
        • Ludewig PM
        • Phadke V
        • Braman JP
        • Hassett DR
        • Cieminski CJ
        • LaPrade RF.
        Motion of the shoulder complex during multiplanar humeral elevation.
        J Bone Jt Surg. 2009; 91: 378-389
        • Wei P
        • Zhu L
        • Chen K
        • Jia W
        • Hu Y
        • Su F.
        Axillary web syndrome following secondary breast-conserving surgery: a case report.
        World J Surg Oncol. 2013; 11: 1
        • Johansson S
        • Svensson H
        • Denekamp J.
        Dose response and latency for radiation-induced fibrosis, edema, and neuropathy in breast cancer patients.
        Int J Radiat Oncol Biol Phys. 2002; 52: 1207-1219
        • Johansen J
        • Overgaard J
        • Blichert-Toft M
        • Overgaard M.
        Treatment morbidity associated with the management of the axilla in breast-conserving therapy.
        Acta Oncol (Madr). 2000; 39: 349-354
        • Ludewig PM
        • Hassett DR
        • LaPrade RF
        • Camargo PR
        • Braman JP.
        Comparison of scapular local coordinate systems.
        Clin Biomech. 2010; 25: 415-421
        • Lang AE
        • Dickerson CR
        • Kim SY
        • Stobart J
        • Milosavljevic S.
        Impingement pain affects kinematics of breast cancer survivors in work-related functional tasks.
        Clin Biomech. 2019; 70: 223-230
        • Lawrence RL
        • Braman JP
        • Ludewig PM.
        Shoulder kinematics impact subacromial proximities: a review of the literature.
        Braz J Phys Ther. 2019; 24: 219-230
        • Vermeulen HM
        • Stokdijk M
        • Eilers PHC
        • Meskers CGM
        • Rozing PM
        • Vliet Vlieland TPM
        Measurement of three dimensional shoulder movement patterns with an electromagnetic tracking device in patients with a frozen shoulder.
        Ann Rheum Dis. 2002; 61: 115-120
        • Prieto-Gómez V
        • Navarro-Brazález B
        • Sánchez-Méndez Ó
        • De-la-Villa P
        • Sánchez-Sánchez B
        • Torres-Lacomba M.
        Electromyographic analysis of shoulder neuromuscular activity in women following breast cancer treatment: a cross-sectional descriptive study.
        J Clin Med. 2020; 9: 1804
        • Borstad JD
        • Ludewig PM.
        The effect of long versus short pectoralis minor resting length on scapular kinematics in healthy individuals.
        J Orthop Sports Phys Ther. 2005; 35: 227-238
        • Yang EJ
        • Park WB
        • Seo KS
        • Kim SW
        • Heo CY
        • Lim JY.
        Longitudinal change of treatment-related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: a prospective cohort study.
        J Surg Oncol. 2010; 101: 84-91