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

Renata Braudy; Brittany Atoms; Jenna Coghlan; Meaghan Staples; David Moga; Ryan Tollefsrud; Rebekah L Lawrence; Paula Ludewig; Linda Koehler

doi:10.1016/j.apmr.2022.09.014

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

Arch Phys Med Rehabil. 2023 Mar;104(3):403-409. doi: 10.1016/j.apmr.2022.09.014. Epub 2022 Oct 4.

Authors

Renata Braudy¹, Brittany Atoms², Jenna Coghlan², Meaghan Staples², David Moga², Ryan Tollefsrud², Rebekah L Lawrence³, Paula Ludewig⁴, Linda Koehler⁴

Affiliations

¹ Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN. Electronic address: rbraudy@umn.edu.
² Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN.
³ Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO.
⁴ Department of Rehabilitation Medicine, Division of Rehabilitation Science, University of Minnesota, Minneapolis, MN; Department of Rehabilitation Medicine, Division of Physical Therapy, University of Minnesota, Minneapolis, MN.

PMID: 36202228
DOI: 10.1016/j.apmr.2022.09.014

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: Axillary Web Syndrome; Breast Neoplasms; Cording; Kinematics; Lymph Nodes; Rehabilitation; Scapula; Shoulder.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Biomechanical Phenomena
Breast Neoplasms*
Case-Control Studies
Female
Humans
Range of Motion, Articular
Scapula
Shoulder
Shoulder Joint*

Abstract

Publication types

MeSH terms

Grants and funding