Lang Angelica E, Dickerson Clark R, Kim Soo Y, Stobart Jamie, Milosavljevic Stephan
Department of Health Sciences, College of Medicine, University of Saskatchewan, Canada.
Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Canada.
Clin Biomech (Bristol). 2019 Dec;70:223-230. doi: 10.1016/j.clinbiomech.2019.10.001. Epub 2019 Oct 19.
Breast cancer survivors may encounter upper limb morbidities post-surgery. It is currently unclear how these impairments affect arm kinematics, particularly during functional task performance. This investigation examined upper body kinematics during functional tasks for breast cancer survivors and an age-matched control group.
Fifty women (aged 35-65) participated: 25 breast cancer survivors who had undergone mastectomy and 25 age-range matched controls. Following basic clinical evaluation, including shoulder impingement tests, motion of the torso and upper limbs were tracked during six upper limb-focused functional tasks from which torso, scapular, and thoracohumeral angles were calculated. Between-group differences were evaluated with independent t-tests (p < .05). The breast cancer group was then divided based upon impingement tests and differences between the three new groups were tested with one-way ANOVAs (p < .05).
Breast cancer survivors had higher disability scores, lower range of motion, and lower performance scores. The largest kinematic differences existed between the breast cancer survivors with impingement pain and the two non-pain groups. During overhead tasks, right peak scapular upward rotation was significantly reduced (d = 0.80-1.11) in the breast cancer survivors with impingement pain. This group also demonstrated trends of decreased peak humeral abduction and internal rotation at extreme postures (d = 0.54-0.78). These alterations are consistent with kinematics considered high risk for rotator cuff injury development.
Impingement pain in breast cancer survivors influences functional task performance and may be more important to consider than self-reported disability when evaluating pain and potential injury development.
乳腺癌幸存者术后可能会出现上肢疾病。目前尚不清楚这些损伤如何影响手臂运动学，尤其是在执行功能性任务期间。本研究调查了乳腺癌幸存者和年龄匹配的对照组在执行功能性任务时的上身运动学情况。
50名女性（年龄在35 - 65岁之间）参与了研究：25名接受过乳房切除术的乳腺癌幸存者和25名年龄匹配的对照组。在进行包括肩部撞击试验在内的基本临床评估后，在六项以上肢为重点的功能性任务中跟踪躯干和上肢的运动，从中计算出躯干、肩胛骨和胸肱角度。采用独立t检验评估组间差异（p < 0.05）。然后根据撞击试验将乳腺癌组进行划分，并用单因素方差分析检验三个新组之间的差异（p < 0.05）。
乳腺癌幸存者的残疾评分更高，活动范围更小，表现得分更低。有撞击疼痛的乳腺癌幸存者与两个无疼痛组之间存在最大的运动学差异。在进行过头任务时，有撞击疼痛的乳腺癌幸存者的右肩胛骨向上旋转峰值显著降低（d = 0.80 - 1.11）。该组在极端姿势下还表现出肱骨外展和内旋峰值降低的趋势（d = 0.54 - 0.78）。这些改变与被认为是肩袖损伤发展高风险的运动学情况一致。
乳腺癌幸存者的撞击疼痛会影响功能性任务表现，在评估疼痛和潜在损伤发展时，可能比自我报告的残疾情况更值得考虑。
