Department of Internal Medicine, Konkuk University Medical Center, Seoul, 05030, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05030, Republic of Korea.
Sci Rep. 2020 Oct 8;10(1):16792. doi: 10.1038/s41598-020-73769-8.
Chronic shoulder pain is a common complication in breast cancer patients after surgery. Chronic shoulder pain after breast cancer surgery was formerly considered as neuropathic pain, however the pathophysiology including structural damages has not been assessed comprehensively. We hypothesized that the structural change could be one of the cause of shoulder pain after breast cancer surgery and evaluated various ultrasonography findings of the shoulder in breast cancer patients with chronic shoulder pain. Patients who were suffering from chronic shoulder pain on unilateral side for at least 3 months after breast cancer surgery were enrolled from a single tertiary hospital. Demographic and clinical data were collected at the baseline. Articular and adjacent structures of both shoulders (painful and contralateral side) were evaluated by ultrasonography. The ultrasonography findings were compared between painful and contralateral sides. Logistic regression analysis was performed to determine the factors associated with abnormal ultrasonography findings. Fifty-two female patients (average age of 55) were enrolled. Significantly more abnormal ultrasonography findings were observed in the painful side than in the contralateral side [39 (75.0%) vs 11 (21.2%), P < 0.001]. The coracohumeral ligament was significantly thicker in the painful side than in the contralateral side (2.48 ± 0.69 vs 1.54 ± 1.25 mm, P < 0.001); adhesive capsulitis was also more frequent in the painful side [14 (26.9%) vs 0, P < 0.001]. Furthermore, patients with a history of breast cancer surgery on the ipsilateral side were associated with abnormal ultrasonography findings and adhesive capsulitis. This study is the first to evaluate ultrasonography in patients with chronic shoulder pain after breast cancer surgery. The results showed that ultrasonography could reveal several structural problems in these patients.
慢性肩部疼痛是乳腺癌患者手术后的常见并发症。乳腺癌手术后的慢性肩部疼痛以前被认为是神经病理性疼痛，但包括结构损伤在内的病理生理学尚未得到全面评估。我们假设结构变化可能是乳腺癌手术后肩部疼痛的原因之一，并评估了慢性肩部疼痛乳腺癌患者的肩部各种超声检查结果。从一家三级医院招募了单侧乳腺癌手术后至少 3 个月持续慢性肩部疼痛的患者。在基线时收集了人口统计学和临床数据。使用超声评估了双侧肩部（疼痛侧和对侧）的关节和相邻结构。比较了疼痛侧和对侧的超声检查结果。进行逻辑回归分析以确定与异常超声检查结果相关的因素。共纳入 52 名女性患者（平均年龄 55 岁）。疼痛侧的异常超声检查结果明显多于对侧[39（75.0%）对 11（21.2%），P<0.001]。疼痛侧喙肱韧带明显比对侧厚（2.48±0.69 对 1.54±1.25 毫米，P<0.001）；疼痛侧黏连性关节囊炎也更常见[14（26.9%）对 0，P<0.001]。此外，同侧乳腺癌手术史与异常超声检查结果和黏连性关节囊炎相关。这项研究首次评估了乳腺癌手术后慢性肩部疼痛患者的超声检查。结果表明，超声检查可以发现这些患者的一些结构问题。
