Post Mastectomy
Conditions
Keywords
Scapular Mobilization, Proprioceptive Neuromuscular Facilitation, Latissimus Dorsi Flap Breast Reconstruction
Brief summary
this study will be conducted to investigate the effect of scapular mobilization and scapular Proprioceptive neuromuscular facilitation on shoulder dysfunction after latissimus dorsi flap breast reconstruction
Detailed description
Several procedures are available for patients undergoing breast reconstruction including pedicled faps such as latissimus dorsi fap (LDF) and transverse rectus abdomens myocutaneous flap (TRAM), as well as free flap requiring microvascular anastomoses like the deep inferior perforator flap (DIEP). Some of these, like LDF, may be combined with implants to provide adequate volume and symmetry.Surgeons employ the latissimus dorsi flap (LDF) for reconstruction of a large variety of breast cancer surgery defects, including quadrantectomy, lumpectomy, modified radical mastectomy, and others.The Latissimus dorsi (LD) muscle, in its interaction with other muscles of the shoulder plays an important role in shoulder adduction, extension, and internal rotation, as well as scapular depression and lateral flexion of the torso, Daily activities that rely on the function of the LD include swimming, climbing stairs, rising with the aid of the arms, and walking on crutches, There is therefore concern that the LD muscle flap procedure may impair shoulder function.The abnormal scapular biomechanics that occur as a result of dysfunction create abnormal scapular positions that decrease normal shoulder function. Therefore, treatment of shoulder dysfunction should include scapular-mobility exercises, or scapular-mobilization (SM) techniques. scapular mobilization and the combined application of techniques resulted in higher achievements, which may be related to increased scapular mobility and thus, the increased range of motion of the glenohumeral joint after scapular mobilization. Proprioceptive neuromuscular facilitation is an approach to therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function. Limited research is available on the impact combined effect of scapular mobilization and scapular proprioceptive neuromuscular facilitation on shoulder dysfunction after latissimus dorsi flap breast reconstruction Therefore, this study aims to examine the combined therapeutic effect of both techniques on shoulder dysfunction to aid in planning an ideal physical therapy rehabilitation program for shoulder dysfunction after latissimus dorsi flap breast reconstruction.
Interventions
OTHERscapular mobilization and scapular proprioceptive neuromuscular facilitation exercises
for scapular mobilization, The patient will be laying on the affected forearm on their back. The therapist is standing before the patient's affected shoulder, placing the index finger of one hand under the medial scapular border, the other hand grasping the superior border of the scapula. The scapula was moved superiorly and inferiorly for superior and inferior glide, and then the scapula is rotated upward and downward for scapular rotation. Second, with the patient was in the same position the physiotherapist put the ulnar fingers under the medial scapular border and distracted the scapula from the thorax. Sets of 10 repetitions were applied performed at a rate of one cycle per 6 s, with a rest interval of 30 seconds between sets. for PNF is applied by a trained therapist in two diagonals, anterior elevation and posterior depression and posterior elevation and anterior depression with 20 repetitions for each diagonal. plus tradional physical therapy.
OTHERtraditional physical therapy
the patients will recieve the traditional physical therapy program in the form of shoulder Range of motion, stretching and strengthening exercises.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
opaque sealed envelope
Intervention model description
scapular mobilization, scapular PNF and traditional physical therapy
Eligibility
Sex/Gender
FEMALE
Age
40 Years to 55 Years
Healthy volunteers
No
Inclusion criteria
* age ranged from 40 to 55 years. * All patients were female patients suffering from shoulder dysfunction after latissimus dorsi flap breast reconstruction. * All patients suffering from moderate or severe pain on shoulder joint and limited range of motion that may affect daily activities. * All patients begun the treatment program 3 to 4 weeks after LDF breast reconstruction. * Informed consent was obtained from every patient enrolled in the trial.
Exclusion criteria
* Current metastases. * Neurological deficit affecting the shoulder functioning during daily activities. * Pathology of the shoulder joint including rotator cuff tear adhesive capsulitis and tendinitis. * Pain or disorder of the cervical spine, elbow, wrist or hand. * Shoulder surgery, shoulder dislocation fracture acromioclavicular joint osteoarthritis. * Diabetes. * Pregnancy. * Shoulder manipulation under anesthesia, local corticosteroid injection. * Psychological disorders.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| pain intensity | up to eight weeks | The Visual analogue Scale (VAS) will be used for the measurement of pain. It consists of a line usually 100 mm in length, with anchor descriptors such as (in the pain context) "no pain" and "worst pain imaginable" |
| shoulder and arm disability | up to eight weeks | Disability of the arm, shoulder and hand questionnaire will be used to assess shoulder and arm disability. This system gives a percentage disability score of upper limbs where 0 indicates no disability and 100 indicates complete disability. The DASH questionnaire consists of 30 questions assessing the impact of upper limb disability (if any) on activities of daily living. There are also optional sections within the questionnaire examining the effect of their limb function at the work place during sports or when playing musical instruments |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| shoulder range of motion | up to eight weeks | The baseline bubble inclinometer will be used to assess shoulder ROM. |
| scapular upward rotation | up to eight weeks | The baseline bubble inclinometer will be used to assess scapular upward rotation |
| scapular downward rotation | up to eight weeks | The baseline bubble inclinometer will be used to assess scapular downward rotation |
Contacts
CONTACTmadonna isaac, master
Outcome results
None listed