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Three-Dimensional Analysis of Shoulder Motion Limitation Following Treatment for Breast Cancer
Background: Loss of shoulder motion is a common physical morbidity following primary intervention for breast cancer, resulting in functional limitations and minimizing the quality of life for breast cancer survivors. Despite rehabilitation efforts, long-term motion and functional impairments often remain. The loss of shoulder motion is likely the result of tissue fibrosis or scarring, altering the normal kinematics of the shoulder complex. Currently, no analysis of shoulder biomechanics following primary treatment for breast cancer exists. As 5 year survival rates for breast cancer continue to improve, maximizing shoulder function following treatment has the potential to impact the quality of life for many individuals. Hypothesis: Clavicle, scapula and humerus kinematic alterations will be detected in women with shoulder motion loss following surgery and/or radiation therapy. Muscle tissue length and extensibility will also be altered in these individuals. Specific Aims: To determine the three-dimensional clavicle, scapula, and humerus kinematics during arm motions, and to determine the extent of shoulder muscle tissue tightness and extensibility in women who have had surgical or radiation treatment for breast cancer. Study Design: Kinematic data on a cohort of 100 women will be sequentially collected at pre-surgery, post-surgery, and post-radiation therapy sessions. Kinematic data from the contralateral arm will serve as a comparison. The analysis will use electromagnetic motion sensors taped to the skin to record three-dimensional rotations of the clavicle, scapula, and humerus relative to the trunk during arm motions. Shoulder muscle tissue length and extensibility will also be analyzed. The effect of surgical and radiation treatments on movement will be compared across time. Potential Outcomes and Benefits: Clavicle, scapula, and humerus kinematic alterations are likely following therapies. These findings will provide the first detailed information about shoulder motion loss in cancer survivors. Biomechanical findings will provide rationale for adding specific rehabilitation interventions to the current standard of care, and may dictate prevention strategies. Biomechanically based interventions can subsequently be tested for efficacy. Improved rehabilitation will increase motion, impact function, improve quality of life, and minimize costs associated with follow-up care for breast cancer survivors.
Background: A high percentage of women have loss of shoulder motion due to surgery following treatment for breast cancer, resulting in an inability to perform some functional tasks and a diminished quality of life. Rehabilitation of motion loss is helpful for some women following surgery or radiation, however many women continue to have motion and function limitations after treatment. There is currently no research defining the specific cause of the motion loss in these women. One theory for the motion loss is anterior shoulder tissue tightness due to surgical and/or radiation treatments. Hypothesis: Loss of shoulder motion following surgical or radiation treatments will be attributed to limited motion of the clavicle, scapula, and humerus. Muscle length and extensibility will also be altered in cancer survivors. Specific Aims: To determine the three-dimensional clavicle, scapula and humerus motions during arm elevation, and to determine the extent of shoulder muscle tissue tightness in women who have had surgery or radiation therapy for breast cancer. Study design: Shoulder motion of 100 women will be tested before and after surgery for primary breast cancer. Motion will also be tested again after radiation therapy if received. Skin-based electromagnetic motion sensors will record three-dimensional rotations of the clavicle, scapula, and humerus during several arm motions, and muscle tissue length and extensibility will also be determined. Motion of the opposite arm will be used for comparison after treatments. Potential Outcomes and Benefits: It is expected that normal clavicle, scapula, and humerus rotations will be limited following surgery or radiation treatments. Shoulder muscle lengths are also likely to be altered. Determining motion limitations will enable precise, scientifically-based recommendations for prevention of motion loss and for rehabilitation following treatment for breast cancer. Improved rehabilitation will promote function, increase quality of life, and decrease rehabilitation costs.