Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
Ann Med. 2022 Dec;54(1):1058-1066. doi: 10.1080/07853890.2022.2065026.
Breast cancer survivors may be at risk of experiencing rotator cuff disease after treatment. Biomechanical alterations following surgery potentially predispose survivors to develop this disorder.
To examine scapular kinematics in breast cancer survivors with and without impingement pain during an overhead reach task.
A cross-sectional study.
Three surgery groups were included: non-cancer controls, mastectomy-only survivors and post-reconstruction survivors. Breast cancer survivor groups were also categorized by the presence of impingement pain. Scapular motion was tracked during an overhead reach task, performed separately by both arms. Maximum scapular internal rotation, upward rotation and tilt were calculated. Two-way analyses of variance with interactions ( < .05) were used to test the effects of group (control, mastectomy-only, reconstruction) and impingement pain (pain, no pain) on each variable within a (left/right) side.
Scapular kinematics varied with the group by pain interaction. On the right side, the mastectomy-pain group had reduced upward rotation, while the reconstruction-pain group had higher upward rotation (mastectomy-only: 22.9° vs. reconstruction: 31.2°). On the left side, the mastectomy-pain group had higher internal rotation, while the reconstruction-pain group had reduced internal rotation (mastectomy-only: 45.1° vs. reconstruction: 39.3°). However, time since surgery was longer in the mastectomy-pain group than reconstruction-pain group, suggesting there may be a temporal component to kinematic compensations.
There are kinematic alterations in breast cancer survivors that may promote future development of rotator cuff disease. Compensations may begin as protective and progress to more harmful alterations with time.KEY MESSAGESScapular kinematics varied with surgery and pain interaction: upward rotation was lower and internal rotation higher in mastectomy-pain group, while upward rotation was higher and internal rotation lower in reconstruction-pain group.Kinematics alterations may also be associated with time since surgery, as the mastectomy-pain group had longer time since surgery than the reconstruction-pain group.Kinematic alterations may transition from protective to harmful over time.In-depth analyses by reconstruction type are needed to determine surgery-specific effects on kinematics and their potential impact on the development of rotator cuff disease.
乳腺癌幸存者在治疗后可能有患上肩袖疾病的风险。手术后的生物力学改变可能使幸存者更容易患上这种疾病。
在过顶伸展任务中，检查有和没有撞击痛的乳腺癌幸存者的肩胛骨运动学。
一项横断面研究。
纳入了三组手术：非癌症对照组、单纯乳房切除术幸存者组和重建术后幸存者组。乳腺癌幸存者组还根据撞击痛的存在进行了分类。在过顶伸展任务中，分别对双侧手臂进行肩胛骨运动追踪。计算最大肩胛骨内旋、上旋和倾斜。采用双向方差分析（交互作用，<0.05），检验组（对照组、单纯乳房切除术组、重建组）和撞击痛（疼痛、无疼痛）对每侧（左/右）变量的影响。
肩胛骨运动学随疼痛组的相互作用而变化。在右侧，乳房切除术疼痛组的上旋减少，而重建疼痛组的上旋增加（乳房切除术：22.9°，重建：31.2°）。在左侧，乳房切除术疼痛组的内旋增加，而重建疼痛组的内旋减少（乳房切除术：45.1°，重建：39.3°）。然而，乳房切除术疼痛组的手术时间比重建疼痛组长，这表明运动学补偿可能存在时间成分。
乳腺癌幸存者存在肩胛骨运动学改变，可能促进未来肩袖疾病的发展。代偿可能最初是保护性的，随着时间的推移，可能会发展为更有害的改变。
肩胛骨运动学随手术和疼痛的相互作用而变化：乳房切除术疼痛组的上旋较低，内旋较高，而重建疼痛组的上旋较高，内旋较低。运动学改变也可能与手术时间有关，因为乳房切除术疼痛组的手术时间比重建疼痛组长。随着时间的推移，运动学改变可能从保护性转变为有害性。需要对重建类型进行深入分析，以确定手术对运动学的具体影响及其对肩袖疾病发展的潜在影响。
