Electromyographic Analysis of Shoulder Neuromuscular Activity in Women Following Breast Cancer Treatment: A Cross-Sectional Descriptive Study

Abstract

Certain secondary effects derived from medical treatment in breast cancer can favor the development of alterations in shoulder biomechanics. To the best of our knowledge, persistent peripheral pain as a key factor for the development of neuromuscular activity impairments has not been analyzed. A cross-sectional descriptive study was carried out. A total of 90 women were included and allocated to three groups: (i) 30 women with persistent peripheral pain after breast cancer treatment, (ii) 30 women without pain after breast cancer treatment, and (iii) 30 healthy women. Surface electromyography was employed to measure the onset and amplitude of the muscle activity of three shoulder movements. Statistically significant differences were found in the neuromuscular activity for all the muscles and shoulder movements among women with persistent pain versus healthy women (i.e., amplitude muscle activity variable p < 0.001). Statistically significant differences were also observed in the neuromuscular activity for certain muscles in shoulder movements among women with persistent pain versus women without pain, as well as between women without pain versus healthy women. Therefore, following breast cancer treatment, women showed alterations in their shoulder neuromuscular activity, which were more significant if persistent pain existed. These findings may contribute to developing a selective therapeutic exercise program that optimizes the shoulder neuromuscular activity in women after breast cancer treatment.

Altered upper limb motor behavior in breast cancer survivors and its relation to pain: A narrative review

“…Applying this reasoning to BCS and the results of this review, protective posturing of the shoulder and reducing the shoulder ROM might be adequate in the acute stage after the breast surgery to promote wound healing and avoid seroma formation. This is reflected in our results, which indicate a higher EMG amplitude in the upper trapezius and deltoideus in BCS (Galiano-Castillo et al, 2011;Prieto-G omez et al, 2020) and ROM reductions that relate to the extent of medical treatment modality, mainly in the first post-operative stage (Hidding et al, 2014;Hodges & Smeets, 2015). When such protective behavior persists after adequate healing has occurred, as based on inappropriate beliefs (e.g., the reduced shoulder ROM seen in BCS at the long term after surgery with high levels of pain catastrophizing), it may be a potential source of nociceptive peripheral input and contribute to the development of persistent pain in BCS.…”

“…No systematic review or prospective research evidence on the association between pain and upper limb motor behavior in BCS is found. Few cross‐sectional research is identified in which motor behavioral outcomes are compared between in BCS with shoulder pain and BCS without shoulder pain or a healthy control group (Galiano‐Castillo et al, 2011; Lang et al, 2019, 2022; Lang, Kim, et al, 2020; Lang, Milosavljevic, et al, 2020; Prieto‐Gómez et al, 2020; Rasmussen et al, 2021; Shamley et al, 2009). In these studies, reduced ROM (for shoulder flexion, horizontal abduction, shoulder abduction, and external shoulder rotation; Lang et al, 2019; Rasmussen et al, 2021), kinematic alterations at the scapulothoracic joint (reduced scapulothoracic upward rotation post‐mastectomy (Lang et al, 2019, 2022; Lang, Milosavljevic, et al, 2020); increased scapulothoracic internal rotation post‐mastectomy (Lang et al, 2022)), alterations in scapulohumeral rhythm (Lang, Milosavljevic, et al, 2020) and changes in shoulder muscle activation (Lang, Kim, et al, 2020; Prieto‐Gómez et al, 2020) are reported in the BCS experiencing subacromial pain in comparison to a control group or BCS without pain.…”

“…Few cross‐sectional research is identified in which motor behavioral outcomes are compared between in BCS with shoulder pain and BCS without shoulder pain or a healthy control group (Galiano‐Castillo et al, 2011; Lang et al, 2019, 2022; Lang, Kim, et al, 2020; Lang, Milosavljevic, et al, 2020; Prieto‐Gómez et al, 2020; Rasmussen et al, 2021; Shamley et al, 2009). In these studies, reduced ROM (for shoulder flexion, horizontal abduction, shoulder abduction, and external shoulder rotation; Lang et al, 2019; Rasmussen et al, 2021), kinematic alterations at the scapulothoracic joint (reduced scapulothoracic upward rotation post‐mastectomy (Lang et al, 2019, 2022; Lang, Milosavljevic, et al, 2020); increased scapulothoracic internal rotation post‐mastectomy (Lang et al, 2022)), alterations in scapulohumeral rhythm (Lang, Milosavljevic, et al, 2020) and changes in shoulder muscle activation (Lang, Kim, et al, 2020; Prieto‐Gómez et al, 2020) are reported in the BCS experiencing subacromial pain in comparison to a control group or BCS without pain. Regarding these changes in muscle activity in BCS with subacromial pain, an increased post‐mastectomy peak force of pectoralis major, upper trapezius, and supraspinatus is reported (Lang, Kim, et al, 2020).…”

The Rehabilitation Tailor: Applying Personalized Medicine to Cancer Recovery

“…Through the use of inertial sensors (G sensor, BTS bioengineering, Quincy, MA, USA) the range of movement of the shoulder is expressed in degrees, and the angular velocity that the patient can reach in the various movements (arm abduction, adduction, and rotation). Subsequently, with surface electromyography (Freeemg 1000, BTS bioengineering Quincy, MA, USA), the fluidity of the movement is evaluated (Jerk index), and the percentage contribution of each muscle investigated to the movement is studied, as well as the effort made by the patient in muscular terms to reach certain angles of movement, which is consistent with other experiences described in the literature ( 6 ). A final assessment then involves evaluating a possible decrease in muscle mass and strength, the so-called sarcopenia, which often stands as a consequence of oncological treatments ( 7 ).…”

Changes in shoulder outcomes using ultrasonographic assessment of breast cancer survivors: a prospective longitudinal study with 6-month follow-up

“…Regarding the active range of motion and strength of the shoulder, a recent study reported that women treated for breast cancer showed alterations in shoulder neuromuscular activity, in both the onset and amplitude of muscle activity, and the changes seemed to be more significant in the presence of persistent pain 45 . These alterations have also been observed in subacromial syndrome as a possible compensation for rotator cuff deficiencies 46 , 47 .…”