Upper extremity strength and range of motion and their relationship to function in breast cancer survivors

Abstract

The impact upper extremity impairments (UE) have on UE function in breast cancer survivors (BCS) is unclear. The purpose of this study was to evaluate the associations between upper extremity active range of motion (AROM), passive range of motion (PROM), and strength with self-reported function in BCS. BCS (n = 24) completed the Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PSS). AROM and PROM of shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction were measured using a digital inclinometer. Strength was measured using a hand-held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, IR, ER, scaption, and horizontal adduction. All constructs of AROM, PROM, and strength were correlated with the DASH and PSS. DASH was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 6 of 7 shoulder strength measures. PSS was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 4 of 7 shoulder strength measures. Regression analysis showed that AROM explained 40% of the DASH scores and strength explained 20% of scores on the PSS. This study characterizes the impact that shoulder motion, flexibility, and strength losses have on shoulder function in BCS. Deficits in AROM and shoulder strength explained the greatest proportion of shoulder disability. Future clinical trials should consider incorporating AROM and strengthening techniques to improve shoulder use after breast cancer treatments.

Pilot study of effective methods for measuring and stretching for pectoral muscle tightness in breast cancer patients

“…At the end of the 4-week stretching treatment, an improvement in shoulder horizontal abduction was detected, but it did not lead to an improvement in upper-extremity symptoms, function, or quality of life. A previous study showed that the DASH score had the strongest correlation with shoulder range of motion, including rotation and abduction33 ) . However, no study has revealed a correlation between the presence of PMT and the DASH score.…”

The impact of breast cancer-related lymphedema on the ability to perform upper extremity activities of daily living

“…Harrington et al studied the association of clinical measures of active and passive shoulder range of motion and strength with the scores from the DASH and from the pennsylvania shoulder scores (PENN) in 24 breast cancer patients. They reported a moderate to high correlation between active range of motion with the DASH, and strength with the PENN [15]. Although the study had strengths, it is limited by its small sample size and lack of assessment of other domains such as fatigue and pain.…”

“…Many authors rely on self-report using a variety of functional surveys, while other authors define function using clinical measurements of upper extremity range of motion and strength to indicate function [15,17,21,22,[39][40][41][42][43]. Lack of clinical measures to determine functional ability has been criticized [44]; however, there is little evidence in the literature that clinical measures of range of motion and strength can be used as a proxy for function.…”

“…Other treatment-related factors including fatigue, pain, loss of upper extremity range of motion and strength, anxiety, changes in weight, unemployment, and neuropathy have also been suggested to compromise function and QOL [8,[15][16][17][18][19][20][21][22][23].…”

Breast Cancer Rehabilitation

“…Research suggests assessing scapula abduction and upward rotation, scapula depression and adduction, glenohumeral fl exion, internal rotation, scaption, and horizontal adduction strength as these were highly correlated with upper extremity functional loss in women diagnosed with breast cancer. 25 It is recommended that strength assessments be performed in a standardized manner such as published in Kendall et al 26 …”