Post Mastectomy
Conditions
Keywords
Proximal stabilization
Brief summary
This prospective, single-center, assessor-blinded, parallel-group randomized controlled trial investigated whether adding proximal motor control exercises (PMCE) to conventional physiotherapy treatment (CPT) improved shoulder function and scapular muscle activation in women with post-mastectomy shoulder dysfunction. Women aged 35-55 years were randomly allocated to receive either PMCE plus CPT or CPT alone. Both groups attended supervised physiotherapy sessions three times weekly for 6 weeks. Outcomes were assessed at baseline, immediately after treatment, and at 12-week follow-up. The primary outcome was scapular and shoulder muscle activation assessed using surface electromyography (SEMG), while secondary outcomes included shoulder pain and disability assessed using the Shoulder Pain and Disability Index (SPADI).
Detailed description
This single-center, prospective, assessor-blinded, randomized controlled trial investigated whether adding proximal motor control exercises (PMCE) to conventional physiotherapy treatment (CPT) improved shoulder function and scapular muscle activation in women with post-mastectomy shoulder dysfunction. Eligible participants were randomly assigned to receive either PMCE plus CPT or CPT alone. Both groups attended supervised physiotherapy sessions three times weekly for six weeks. PMCE focused on improving scapular alignment, neuromuscular coordination, and activation of scapular stabilizing muscles, whereas CPT included glenohumeral joint mobilization, posterior capsule stretching, and Codman pendulum exercises. Outcomes were assessed at baseline, immediately after treatment, and at 12-week follow-up. The primary outcome was scapular and shoulder muscle activation assessed using surface electromyography (SEMG). The secondary outcome was shoulder pain and disability assessed using the Shoulder Pain and Disability Index (SPADI). The study aimed to determine whether PMCE combined with CPT provided greater improvements in neuromuscular and clinical outcomes than CPT alone.
Interventions
OTHERProximal Motor Control exercises
The PMCE program was: Participants were trained to achieve and maintain optimal scapular positioning using visual, verbal, tactile, and kinesthetic feedback, followed by controlled arm elevation to 90° in the sagittal, frontal, and scapular planes. Muscle-specific exercises included prone 135° elevation for the lower trapezius, wall slides with scapular protraction for the serratus anterior, full-can scaption for the supraspinatus, and resisted external rotation for the infraspinatus. Upper trapezius activation was incorporated during controlled arm elevation. Exercises were performed for three sets of 10 repetitions with 6-second holds and 60-90 seconds of rest. Resistance started at approximately 0.5-1.0 kg and was progressively increased according to the participant's ability to maintain proper scapular alignment without compensatory movement or increased symptoms. The PMCE program was administered three times per week for six consecutive weeks.
OTHERConventional physical therapy
CPT consisted of glenohumeral joint mobilization, posterior capsule stretching, and Codman pendulum exercises. Joint mobilization included distraction, caudal, and posterior glides using Grade 1-2 oscillations for approximately 2 minutes. Posterior capsule stretching was performed with the shoulder at 90° flexion, holding each stretch for 20 seconds for 10 repetitions with 30 seconds of rest. Codman pendulum exercises were performed in anterior-posterior, medial-lateral, and circular directions without resistance to facilitate gentle shoulder mobility. The CPT program was administered three times per week for six consecutive weeks.
Sponsors
Ahram Canadian University
Benha University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
The SPADI assessor, SEMG examiner, and statistician remained blinded to group allocation throughout data collection and analysis.
Intervention model description
This is a parallel group randomized controlled trial
Eligibility
Sex/Gender
FEMALE
Age
35 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
Had stage I-III unilateral breast cancer. Had undergone simple or modified radical mastectomy at least 3 months before enrollment. Had achieved complete postoperative wound healing and were medically stable. Had clearance from their treating physician to participate in exercise. Presented with post-mastectomy shoulder dysfunction, defined as a SPADI score ≥30/100 and a positive Scapular Dyskinesis Test.
Exclusion criteria
Had undergone bilateral mastectomy. Had evidence of locoregional recurrence or metastatic breast cancer. Had a history of previous shoulder surgery or major shoulder trauma unrelated to breast cancer treatment. Had pre-existing shoulder disorders, including rotator cuff tears, adhesive capsulitis, or advanced glenohumeral osteoarthritis. Had neurological disorders affecting upper-limb function. Had rheumatologic diseases affecting shoulder function. Had uncontrolled diabetes mellitus or any other medical condition contraindicating exercise participation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| EMG Muscle Activation | Baseline, 6 weeks and 12 weeks follow up | Surface electromyography (sEMG) was used to assess the activation patterns of the serratus anterior, upper and lower trapezius, supraspinatus, and infraspinatus muscles during arm elevation. The sEMG assessment was conducted using a wireless sEMG system with a sampling rate of 2000 Hz and a bandwidth of 20-500 Hz. Pre-gelled, disposable, self-adhesive Ag/AgCl electrodes were placed over the muscle bellies according to the SENIAM recommendations, with an inter-electrode distance of 20 mm. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Shoulder pain and disability index (SPADI) | Baseline, 6 weeks and 12 weeks follow up | The Shoulder Pain and Disability Index (SPADI) was used to assess shoulder pain and disability. It is a self-administered questionnaire with established reliability and sensitivity, consisting of 13 items across two domains: pain (5 items) and disability (8 items). Participants selected the number that best reflected their pain or difficulty on a scale ranging from 0 to 10. The scores of the pain and disability subscales were averaged to calculate a total percentage score, with higher scores indicating greater shoulder pain and dysfunction. |
Countries
Egypt
Contacts
STUDY_DIRECTORMohamed Naeem, Ph.D
Faculty of Physical Therapy, Beni Sueif university
Outcome results
None listed