Scapulothoracic Stabilization and Postural Training in Upper Extremity Lymphedema

Effects of Scapulothoracic Stabilization and Postural Training Added to Standard Lymphedema Care on Muscle Strength, Posture and Functional Outcomes in Secondary Upper Extremity Lymphedema: A Single-Center Randomized Controlled Trial

This single-center randomized controlled trial aims to investigate the effects of adding scapulothoracic stabilization and postural training to standard lymphedema care in women with secondary upper extremity lymphedema following breast cancer surgery. Participants will be randomly assigned to receive either standard lymphedema care alone or standard care combined with scapulothoracic stabilization and postural training. Outcomes including scapular muscle strength, posture, upper extremity function, limb volume, and neck awareness will be assessed at baseline, immediately after treatment, and at a 2-month follow-up. The findings are expected to provide evidence regarding the effectiveness of incorporating targeted stabilization and postural exercises into conventional lymphedema rehabilitation.

Study Overview

• Status: Recruiting
• Conditions: Secondary Lymphedema
• Intervention / Treatment: Procedure: Complex Decongestive Therapy; Behavioral: Scapulothoracic Stabilization and Postural Training

Detailed Description

Secondary upper extremity lymphedema is a common complication following breast cancer treatment and is characterized by chronic swelling, pain, reduced muscle strength, impaired upper extremity function, and postural alterations. These impairments may negatively affect daily activities, body perception, and quality of life. Although Complex Decongestive Therapy (CDT) is considered the gold standard for lymphedema management, conventional treatment primarily focuses on edema reduction and does not specifically address scapular stability, postural alignment, or neuromuscular control.

Altered scapulothoracic biomechanics and postural dysfunction are frequently observed in individuals with breast cancer-related lymphedema. These impairments may contribute to shoulder dysfunction, muscle weakness, compensatory movement patterns, and persistent functional limitations. Scapulothoracic stabilization exercises aim to restore scapular muscle balance and improve dynamic shoulder stability, whereas postural training promotes optimal alignment and body awareness. The combined application of these interventions may enhance functional recovery beyond the effects of standard CDT alone; however, evidence from randomized controlled trials remains limited.

This single-center, prospective, randomized controlled trial aims to evaluate the effectiveness of adding scapulothoracic stabilization and postural training to standard lymphedema care in women with secondary upper extremity lymphedema following breast cancer surgery. Participants will be randomly allocated to either a control group receiving standard lymphedema care or an intervention group receiving standard care plus scapulothoracic stabilization and postural training. Randomization will be performed using a computer-generated allocation sequence, and all outcome assessments will be conducted by a blinded assessor.

Outcome measures will be collected at baseline, immediately after completion of treatment, and at a 2-month follow-up. Primary and secondary outcomes will include scapular muscle strength measured with a handheld dynamometer (MicroFET2), postural alignment assessed using the PostureScreen application, upper extremity function evaluated with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, limb volume calculated from serial circumference measurements, and neck awareness assessed using the Fremantle Neck Awareness Questionnaire (FreNAQ). The findings of this study are expected to provide evidence regarding the clinical benefits of incorporating targeted scapulothoracic stabilization and postural training into conventional lymphedema rehabilitation and may contribute to the development of more comprehensive rehabilitation protocols for breast cancer survivors.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: İdil Esin Ünlü, Assist. Prof. Dr.; Phone Number: +90 506 515 66 22; Email: idil.unlu@toros.edu.tr

Study Locations

• Turkey (Türkiye)
  • Adana, Turkey (Türkiye)
    • Recruiting
    • Adana Şehir Eğitim ve Araştırma Hastanesi
    • Contact: Deniz TUNCA, PT; Phone Number: +90 532 409 36 33; Email: denizcanoglu82@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Female patients aged 18 to 65 years.
• Diagnosed with secondary upper extremity lymphedema following breast cancer surgery (mastectomy).
• Willing to participate in the study.
• Able to provide written informed consent.

Exclusion Criteria:

• Active infection (e.g., cellulitis or lymphangitis).
• Advanced shoulder or cervical pathology.
• Neurological disorders affecting upper extremity function.
• Metastatic disease.
• Receiving active chemotherapy.
• Participation in another intensive lymphedema rehabilitation program within the previous 3 months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Scapulothoracic Stabilization; Participants assigned to the experimental group will receive standard Complex Decongestive Therapy (CDT), including manual lymphatic drainage, compression therapy, skin care, and therapeutic exercises, together with a structured scapulothoracic stabilization and postural training program. The additional exercise program is designed to improve scapular muscle function, postural alignment, and upper extremity function. Assessments will be performed at baseline, immediately after treatment, and at a 2-month follow-up.	Procedure: Complex Decongestive Therapy; Standard Complex Decongestive Therapy consisting of manual lymphatic drainage, compression therapy, skin care, and therapeutic exercises. Treatment will be delivered according to established clinical guidelines and routine lymphedema rehabilitation protocols.; Behavioral: Scapulothoracic Stabilization and Postural Training; A supervised exercise program consisting of scapulothoracic stabilization exercises and postural training designed to improve scapular muscle strength, postural alignment, and upper extremity function. The program will be provided in addition to standard Complex Decongestive Therapy throughout the treatment period.
Active Comparator: Control; Participants assigned to the control group will receive standard Complex Decongestive Therapy (CDT), including manual lymphatic drainage, compression therapy, skin care, and therapeutic exercises according to routine clinical practice. Outcome assessments will be performed at baseline, immediately after treatment, and at a 2-month follow-up.	Procedure: Complex Decongestive Therapy; Standard Complex Decongestive Therapy consisting of manual lymphatic drainage, compression therapy, skin care, and therapeutic exercises. Treatment will be delivered according to established clinical guidelines and routine lymphedema rehabilitation protocols.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Upper Extremity Function	Upper extremity function will be assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The DASH is a validated 30-item patient-reported outcome measure evaluating symptoms and functional limitations of the upper extremity. Scores range from 0 to 100, with higher scores indicating greater disability.	Baseline, immediately after completion of treatment, and 2 months after treatment
Change in Head Anterior Translation	Head anterior translation will be assessed using the PostureScreen mobile application.	Baseline, immediately after completion of treatment, and 2 months after treatment
Change in Shoulder Height Asymmetry	Shoulder height asymmetry will be assessed using the PostureScreen mobile application.	Baseline, immediately after completion of treatment, and 2 months after treatment.
Change in Shoulder Anterior Translation	Shoulder anterior translation will be assessed using the PostureScreen mobile application.	Baseline, immediately after completion of treatment, and 2 months after treatment.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Scapular Muscle Strength	Scapular muscle strength (upper, middle, and lower trapezius muscles) will be measured using a handheld dynamometer (MicroFET2) with the isometric make-test method.	Baseline, immediately after completion of treatment, and 2 months after treatment

Collaborators and Investigators

• Sponsor: Toros University

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2026
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): March 1, 2027

Study Registration Dates

• First Submitted: July 6, 2026
• First Submitted That Met QC Criteria: July 10, 2026
• First Posted (Actual): July 13, 2026

Study Record Updates

• Last Update Posted (Actual): July 13, 2026
• Last Update Submitted That Met QC Criteria: July 10, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Posture; Muscle Strength; Upper Extremity Lymphedema; Scapulothoracic Stabilization; Postural Training
• Other Study ID Numbers: 25.02.2026-1214/23

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No