Surgical Intervention and Physiotherapy in Breast Cancer: Effects in Scapular Kinematics, Pain and Upper Limb Function

The main disorders of upper limb related to postoperative breast cancer, as functional limitations and muscle weakness, have already been studied. Three-dimensional scapula movement can be altered after surgical treatment of this condition, but the studies are inconclusive on this topic. Objective: To identify the possible changes of three-dimensional scapula kinematics during arm elevation in women after breast cancer surgery and subjected to a physical therapy intervention. Also to evaluate pain, upper limb function and quality of life. Methods: Will be evaluated 25 women with a clinical diagnosis of breast cancer and 25 healthy controls women with no history of musculoskeletal disorders of upper limbs and matched with age and body mass index. There will be two pre-surgical evaluations in the month prior to surgical treatment of breast cancer (with an interval of one week between then) and two post-surgical assessments: the first, after 4 weeks after surgery, when patients have received 8 sessions (twice a week) of physical therapy in upper limb (passive mobilization in glenohumeral joint and scapular, scar massage, lymphatic drainage, stretching exercises); the second, after 8 weeks after surgery, when patients completed 16 sessions (twice a week) of physical therapy for shoulder complex (strengthening and stretching exercises). In each evaluation, bilateral scapular kinematics will be analyzed by an electromagnetic tracking device during arm lifting movement in scapula plane, in breast cancer group. For control group, the assessed side will be correspondent to dominant or non-dominant operated side. Flexion, abduction, external and internal rotation of each arm will be assessed by a digital inclinometer. Muscle strength of abductors and external rotators will be evaluated by a hand held dynamometer. Pain will be assessed by visual analog scale (VAS) and upper limb function will be assessed by Disabilities of the Arm and Shoulder and Hand (DASH) questionnaire. Quality of life, through the Medical Outcomes Study 36 questionnaire -item Short Form Health Survey (SF36). Statistical analysis will include analysis of qualitative and quantitative variables. Statistical tests will be applied according to the normality of the data and it will adopt a 5% of significance level for variables comparisons along evaluations. Expected results and clinical implications of the study: To provide information of shoulder and scapular biomechanics in women after surgery for breast cancer.