Seven exercises to improve limited shoulder mobility after breast cancer surgery

The breast cancer surgery went smoothly, but my shoulders feel very stiff and cannot move freely. I can’t even do normal activities like combing my hair or buttoning my back. What should I do?

The Importance of Shoulder Mobility

Shoulder joint function plays an important role in the entire upper limb function. Its loss will lead to 60% loss of upper limb function. According to statistics, the incidence of shoulder dysfunction in patients after breast cancer surgery is 2% to 51%, which is one of the most common complications after breast cancer surgery.

Limited shoulder movement directly leads to the inability to do many things in daily life, such as limited arm movement when dressing, inability to fully reach the back when bathing, difficulty lifting objects, etc.

Why is there limited shoulder mobility?

1. Surgical factors

There are many surgical methods for breast cancer. The operation will damage the muscles, lymph nodes and nerves around the surgical site, leading to local scar tissue formation, fibrosis and soft tissue contracture, and thus limited shoulder movement. Even if the modified radical mastectomy is less invasive and can preserve the pectoralis major and minor muscles, the probability of limited shoulder movement after surgery is still high.

2. Radiotherapy factors

Shoulder joint dyskinesia is the most common complication after radiotherapy for breast cancer. According to statistics, the incidence rates are 57.6% and 65.2% in subjective symptoms and objective signs, respectively. The main reason is that preoperative and postoperative radiotherapy for breast cancer can cause venous occlusion, lymphatic vessel damage, and local muscle fibrosis in the radiation field.

3. Impact of other complications

Subcutaneous effusion and skin flap necrosis will affect the patient's wound healing, forcing them to give up shoulder movement, resulting in varying degrees of shoulder joint movement restriction. Upper limb lymphedema will also affect upper limb movement, thus limiting shoulder joint movement.

Seven exercises to improve limited shoulder mobility

Exercise 1: Wall climbing

Place your hands on the wall and climb up from the bottom. When you feel any discomfort, stop and hold for 10 seconds. Put your hands back to their original position, and then repeat this action. Try to gradually increase the angle and climb higher and higher, until you can finally reach the highest point with both hands level.

Movement 2: Pendulum Movement

Bend over with your arms hanging naturally, and gently shake your arms to make them swing, alternating between front and back and left and right, within the pain-free range. Start with a small swing (about 30 degrees) and then gradually increase the angle to 90 degrees.

Exercise 3: Hands around shoulders

Cross the fingers of both hands and hold them in front of the chest, raise the hands until the shoulders are bent forward 90 degrees, then raise them further and try to go over the top of the head, and then return to the original position.

Exercise 4: Elbow lift exercise

Use the affected hand to hold the elbow of the healthy side, and move in coordination with your breathing. Bend forward and raise your arm when you inhale, and lower your arm when you exhale. Repeat this process.

Exercise 5: Diving start exercise

Bend your hands forward and place them flat, take a deep breath and then exhale and stretch forward, stretch your back like a car body, and get ready for diving. After fully stretching, inhale, exhale and place your hands on your thighs, and straighten your body. In addition to strengthening the forward flexion of the shoulders, this action can also effectively relieve the back muscles and reduce stiffness.

Exercise 6: Chest-opening exercise

Stand upright, cross your hands behind your head, rotate to the right while inhaling, and return to the right position while exhaling. This movement can improve shoulder joint mobility and help open the chest, reduce pain, and improve round shoulders.

Exercise 7: Side bending exercise

Hold your head with both hands, bend your body to the right while inhaling, and feel the left side of your body being completely stretched out. Exhale and return to the normal position, and repeat in the opposite direction. This will improve the limited abduction of the shoulders and effectively stretch the lateral chest and back muscles.

Notice:

It is recommended to continue shoulder activities after the drainage tube is removed.

References:

[1] Duan Ranran, Zhao Zhenbiao, Huai Yaping. Research progress on rehabilitation training for common complications of upper limbs after breast cancer surgery[J]. Chinese Journal of Rehabilitation Theory and Practice, 2017, 23(09): 1007-1010.

[2] Cai Zhongbo, Fang Guizhen. Research progress on influencing factors of shoulder joint dysfunction in patients after breast cancer surgery[J]. Nursing Research, 2016, 30(30): 3730-3734.

Author: Yuan Mei, Bi Xia, Zhao Jiangxia

About the Author

Bi Xia

Bi Xia, Doctor of Medicine, Chief Physician, Master Supervisor, is currently the Director of the Department of Rehabilitation Medicine, Zhoupu Hospital Affiliated to Shanghai University of Medicine and Medical Sciences, and the Vice President of the School of Rehabilitation, Shanghai University of Medicine and Medical Sciences. In 2010, 2018 and 2019, she was selected into the Excellent Discipline Leader and Leading Talent Training Program of the Health System of Pudong New Area. She has published 4 SCI papers and more than 30 core journal papers as the first author and corresponding author.

Professional fields: stroke rehabilitation, fracture postoperative rehabilitation, spinal cord injury rehabilitation, artificial joint perioperative rehabilitation, hand injury rehabilitation, etc.

Main academic positions: Member of the Geriatric Rehabilitation Branch of the Chinese Rehabilitation Medicine Association, Member of the Medical and Nursing Integration Committee of the Chinese Rehabilitation Medicine Association, Rehabilitation Committee Member of the Geriatric Rehabilitation Branch of the Chinese Medical Doctor Association, Executive Director of the Shanghai Rehabilitation Medicine Association, Member of the Physical Medicine and Rehabilitation Branch of the Shanghai Medical Association, Vice Chairman of the Rehabilitation Treatment Committee of the Shanghai Rehabilitation Medicine Association, Member of the Orthopedic Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Member of the Spinal Cord Injury Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Member of the Community Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Member of the Sports Health and Rehabilitation Committee of the Shanghai Rehabilitation Medicine Association, Chairman of the Rehabilitation and Physiotherapy Committee of the Shanghai Pudong New Area Medical Association, and other academic positions.

About the Author

Yuan Mei

Yuan Mei is a therapist at the Department of Rehabilitation Medicine, Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences. She holds a master's degree in rehabilitation therapy and has published three rehabilitation-related papers.

Specializes in postpartum rehabilitation and rehabilitation of cervical and lumbar diseases.

Funded by Shanghai Science and Technology Commission's Science Popularization Project

(Project No.: 20DZ2311100)