“The effect of breast reconstruction on kinematics and performance during upper limb-focused functional tasks”

Abstract

Background: Breast reconstruction after curative breast cancer surgery is becoming increasingly common. There is evidence to suggest that these surgeries have negative effects on shoulder function, but to date there have been no investigations of shoulder biomechanics during functional tasks in this group. The purpose of this study was to define and compare upper limb motion of patients with breast cancer who underwent mastectomy only or mastectomy with reconstruction with a control group without cancer during a range of work-related functional tasks. Methods: Ninety-five women participated: 25 controls, 25 patients with breast cancer who received a mastectomy only, and 45 patients with breast cancer who received a mastectomy with reconstruction (implant, latissimus dorsi flap, or deep inferior epigastric artery perforator flap). Motion of the torso, humeri, and scapulae were tracked during arm-focused functional tasks, involving reaching, dexterity, and lifting overhead, and joint angles were calculated. Mean, maximum, and minimum angles were calculated and compared among groups using one-way analyses of variance (p < 0.05). Results: The reconstruction group had significantly different kinematics than the other two groups. Throughout task performance, patients who had reconstruction had increased scapular posterior tilt and increased humeral external rotation. These findings are consistent with reconstruction surgical procedures and may highlight muscle pattern alterations that interfere with co-contraction, stability, and functional task performance. Conclusions: The findings suggest that breast reconstruction surgery influences functional task performance. Scapular and humeral kinematics may indicate movement pattern differences that are important to address in rehabilitation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Evidence of rotator cuff disease after breast cancer treatment: scapular kinematics of post-mastectomy and post-reconstruction breast cancer survivors

“…In the current manuscript, the same mastectomy-only breast cancer survivors, divided by impingement pain and controls are compared to a newly assessed group: reconstruction breast cancer survivors, divided by impingement pain. Findings regarding reconstruction kinematics, without consideration of impingement pain, have been reported in another publication [ 20 ].…”

“…Breast reconstruction, while invasive and intensive procedures that can cause significant shoulder impairment [ 20 , 21 , 29 ], may help to prevent rotator cuff disease. Findings from our recent work looking at survivors after reconstruction suggest that, when not divided by impingement pain, kinematic alterations after breast reconstruction might reduce risk of rotator cuff disease.…”

“…Findings from our recent work looking at survivors after reconstruction suggest that, when not divided by impingement pain, kinematic alterations after breast reconstruction might reduce risk of rotator cuff disease. Specifically, humeral internal rotation and scapular anterior tilt are both consistently reduced in the reconstruction group [ 20 ]. The hypothesis is that the detrimental effects to the humeral internal rotators (pectoralis major and latissimus dorsi) and strength deficits after surgery could contribute to the kinematic compensations favourable for rotator cuff disease prevention.…”

“…While the combination of mastectomy and impingement pain appears to be associated with potentially harmful kinematics, there are few investigations of breast cancer survivor biomechanics after mastectomy plus reconstruction (termed “reconstruction” in this paper) [ 18 , 20 , 21 ]. Findings from our research group suggest that reconstruction breast cancer survivors have reduced humeral internal rotation and anterior tilt during functional tasks [ 20 ], but that study did not consider impingement-related pain.…”

“…While the combination of mastectomy and impingement pain appears to be associated with potentially harmful kinematics, there are few investigations of breast cancer survivor biomechanics after mastectomy plus reconstruction (termed “reconstruction” in this paper) [ 18 , 20 , 21 ]. Findings from our research group suggest that reconstruction breast cancer survivors have reduced humeral internal rotation and anterior tilt during functional tasks [ 20 ], but that study did not consider impingement-related pain. Therefore, the purpose of this study was to measure scapular kinematics of reconstruction breast cancer survivors, with and without impingement pain, during an overhead reaching task and compare them to mastectomy-only survivors, with and without impingement pain and non-cancer controls.…”