Shoulder Range Of Motion Limitations Research Articles

Abstract P4-07-61: Lymphedema, shoulder range of motion, pain, and presence of cords in patients undergoing breast cancer treatment with axillary web syndrome: Late follow-up

Abstract Introduction: Axillary web syndrome (AWS) is a common complication in the immediate postoperative period in women after breast cancer surgery. The symptoms are defined as the presence of cords, pain, and limited shoulder range of motion (ROM). Pathophysiology has been described as lymphatic thrombosis, which could be a risk factor for the development of lymphedema. Considered by some to be self-limiting, it has been described as a chronic complication, persisting for years after initial onset. Objective: To determine the prevalence of AWS in a longitudinal cohort of women in a late follow-up after breast cancer surgery and to assess shoulder ROM, presence of pain, permanence of cords and correlation with lymphedema. Methods: A longitudinal cohort study was carried out at the Division of Breast Cancer Disease of the Universidade Federal de São Paulo. Twenty-five women were followed up and reassessed regarding the permanence of cords, pain, ROM, and presence of lymphedema. Results: Of the 25 patients analyzed, 64% (16 patients) showed prevalence of AWS. On recall, all cords were palpable and 87.5% were in the axilla. There was no correlation between AWS and lymphedema. Conclusions: AWS is an important complication in the immediate postoperative period, that persists for several years, without restrictions on function, pain or shoulder ROM limitations. We must therefore consider it as a complication that becomes chronic but has no impact on quality of life. The correlation with lymphedema was not significant in our study. Key words: breast neoplasms, axillary web syndrome, physical exercise, articular range of motion, pain, lymphedema. Citation Format: Patricia V. Figueira, Cinira Haddad, Samantha K. Lopes de Almeida Rizzi, Amanda Estevao, Simone Elias, Gil Facina, Afonso Nazário. Lymphedema, shoulder range of motion, pain, and presence of cords in patients undergoing breast cancer treatment with axillary web syndrome: Late follow-up. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-61.

Axillary web syndrome in women after breast cancer surgery referred to an Oncological Rehabilitation Unit: which are the main risk factors? A retrospective case-control study.

Axillary web syndrome (AWS) is a complication of surgical procedures in breast cancer (BC) patients. This condition with poorly understood incidence and etiology is characterized by the locoregional development of scar tissue, leading to subcutaneous cording, motion impairment and pain. The early identification of patients at risk for AWS would improve their clinical management. Here, we sought to characterize the prevalence of and the risk factors associated with AWS in BC women after surgery. All patients with BC that underwent axillary surgery referred to an Outpatient Service for Oncological Rehabilitation were retrospectively collected. These women were assessed two weeks after the surgical procedure for their clinicopathologic features, type of therapeutic interventions, and AWS presence, laterality, pain, localization, cords type, and number of cords. Altogether, 177 patients (mean aged 60.65 ± 12.26 years) were included and divided into two groups: AWSPOS (n=52; 29.4%) and AWSNEG (n=125; 70.6%). Patients with tumor N ≥1 (OR=3.7; p<0.001), subjected to mastectomy, axillary lymph node dissection (ALND) and chemotherapy showed significant correlations with AWS onset (p<0.05). The range of shoulder motion limitation (OR=11.2; p<0.001) and the presence of breast cancer related lymphedema (OR=3.5; p=0.020) were associated with AWS. Mastectomy, ALND, chemotherapy, low staging tumors, shoulder range of motion limitations, and BCRL represent risk factors for AWS onset. Realizing new strategies for assessing the individual risk of AWS is a crucial clinical need to improve the health-related quality of life of BC survivors.

Relationships Between Capsular Stiffness and Clinical Features in Adhesive Capsulitis of the Shoulder

BackgroundTightening and contracture of the joint capsule are hallmarks of adhesive capsulitis of the shoulder (ACS). However, quantification of capsular stiffness and its relation to clinical features have not been investigated thoroughly. ObjectivesTo quantify capsular stiffness during intra-articular hydraulic distension (IHD) and to investigate its relationships with pain severity, symptom duration, range of motion (ROM), gender, and diabetes status. DesignCase series. SettingUniversity outpatient clinic of physical medicine and rehabilitation. ParticipantsA total of 107 consecutive patients with ACS who underwent IHD. MethodsPressure-volume monitoring data during IHD, pain severity, symptom duration, shoulder ROM, and diabetes status were obtained by retrospective chart review. Capsular stiffness (Kcap) was measured by calculating the slope of the elastic phase in pressure-volume curves. ROM was evaluated in 3 directions (flexion, abduction, and external rotation) with a goniometer, and the sum of the 3 ROMs was calculated. Main Outcome MeasurementsPearson correlation coefficients and comparisons of averages were used to analyze the relationships between Kcap and clinical features. ResultsThe mean Kcap of the total group of participants was 26.0 ± 14.2 mmHg/mL. Shoulder pain in motion or rest did not correlate with Kcap. Patients with stiffer capsules had smaller sums of ROMs (r = −.298, P = .002), with distinct limitations in external rotation and abduction (r = −.278, P = .004 and r = −.313, P = .001, respectively). Women had significantly stiffer capsules than men (29.5 ± 14.3 versus 20.2 ± 12.1 mmHg/mL, P = .001). Diabetes status had no significant effect on capsular stiffness. ConclusionsCapsular stiffness of the glenohumeral joint significantly correlated with limitation in shoulder ROM, especially in the abduction and external rotation directions, whereas there were no meaningful relationships with shoulder pain during motion or rest. This is the first study to reveal the relationships between in vivo quantified capsular stiffness and shoulder ROM limitations.

The impact of joint range of motion limitations on health-related quality of life in patients with haemophilia A: a prospective study.

In patients with haemophilia A, repeated occurrences of haemarthrosis and synovitis lead to limitations in range of motion (ROM) of major joints. However, the effect of limitations in joint ROM on health-related quality of life (HRQOL) in these patients has not been studied previously. The aim of this study was to assess the impact of ROM limitations of 10 major joints (bilateral shoulders, elbows, hips, knees and ankles), combined with other possibly influential factors, on HRQOL in patients with haemophilia A. The ROM limitations in 13 movements and pain intensity of the 10 major joints were measured. The socio-demographic and clinical data were recorded. Short-Form 36 was used as the HRQOL measurement. Eighteen patients (mean age: 36.9 years) were included. Hip ROM limitations, knee ROM limitations and hip pain intensity predicted physical functioning scale (P < 0.001; adjusted R2 = 0.553). Shoulder ROM limitations and age predicted role limitation were due to emotional problems scale (P < 0.001; adjusted R2 = 0.373). Elbow ROM limitations and haemophilia severity predicted mental health scale (P = 0.001; adjusted R2 = 0.320). Hip ROM limitations predicted social functioning scale (P = 0.041; adjusted R2 = 0.091). Educational level and elbow ROM limitations predicted vitality scale (P < 0.001; adjusted R2 = 0.416). The ROM limitations of hip, knee, shoulder and elbow could be predictors for HRQOL in patients with haemophilia A. Improving ROM of major joints could be an appropriate treatment strategy to enhance HRQOL in these patients.

Sonography and physical findings in stroke patients with hemiplegic shoulders: A longitudinal study

To investigate the correlation between hemiplegic shoulder pain factors during the acute and chronic stages of stroke recovery. A prospective longitudinal study. Seventy-six stroke patients with hemiplegic shoulders. Hemiplegic shoulder pain and clinical, physical, and sonography results were recorded at admission and during both acute (before discharge) and chronic stages (6 months after discharge). During the acute stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level and range of motion limitations. During the chronic stage, hemiplegic shoulder pain correlated significantly with shoulder motor function level, range of motion limitations, spasticity and abnormal sonographic findings. Higher incidence (p=0.014) of hemiplegic shoulder pain and pain scores (p<0.01) were noted and abnormal sonographic findings of the biceps tendon long head (p=0.01) and subscapularis tendon (p=0.01) were higher during the chronic stage. Effusion, tenosynovitis or tendinopathy of the biceps tendon long head, and supraspinatus tendinopathy were notable during both stages. Hemiplegic shoulder pain was correlated with lower motor function level and shoulder range of motion limitation in both stages. Shoulder spasticity and abnormal sonographic findings were correlated with hemiplegic shoulder pain during the chronic stage.

Correlation of shoulder range of motion limitations at discharge with limitations in activities and participation one year later in persons with spinal cord injury

To study the correlation between limited shoulder range of motion in persons with spinal cord injury at discharge and the performance of activities, wheeling performance, transfers and participation one year later. Multicentre prospective cohort study. A total of 146 newly injured subjects with spinal cord injury. Shoulder range of motion was measured at discharge. One year later, Functional Independence Measure (FIM), transfer ability, wheelchair circuit and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) were assessed. Corrections were made for possible confounding factors (age, gender, level and completeness of injury, time since injury and shoulder pain). All subjects with limited shoulder range of motion at discharge had a lower FIM motor score and were less likely (total group 5 times, and subjects with tetraplegia 10 times less likely) to be able to perform an independent transfer one year later. Subjects with limited shoulder range of motion in the total group needed more time to complete the wheelchair circuit. No significant associations with the PASIPD were found in either group. Persons with spinal cord injury and limited shoulder range of motion at discharge are more limited in their activities one year later than those without limited shoulder range of motion.

Passive shoulder range of motion impairment in spinal cord injury during and one year after rehabilitation

To investigate the prevalence and course of pass notive shoulder range of motion in people with a spinal cord injury and the relationships between shoulder range of motion limitations and personal and lesion characteristics. Multicentre longitudinal study. A total of 199 subjects with spinal cord injury admitted to specialized rehabilitation centres. Assessments of shoulder range of motion at the start of active rehabilitation, 3 months later, at discharge and one year after discharge. Up to 70% (95% confidence interval (CI): 57-81) of the subjects with tetraplegia and 29% (95% CI: 20-38) of those with paraplegia experienced a limited range of motion of the shoulder during, or in the first year after, inpatient rehabilitation. Shoulder flexion was affected most. Up to 26% (95% CI: 20-37) of subjects had a shoulder range of motion limitation on both sides. Increased age, tetraplegia, spasticity of elbow extensors and longer duration between injury and start of active rehabilitation increased the risk. Presence of shoulder pain is associated with limited shoulder range of motion. Limited shoulder range of motion is common following spinal cord injury. Tetraplegia, increased age, spasticity of elbow extensors, longer duration between injury and start of active rehabilitation and shoulder pain are associated with an increased risk for shoulder range of motion problems and require extra attention.