Patients with post
mastectomy soft tissue shoulder disorders usually benefit from various lines of physiotherapy treatment. However, the controversy about their efficacy persists. The aim of this work was to study and assess the efficacy of each, and to identify the best intervention. One hundred female patients with ipsilateral post
mastectomy shoulder problems were enrolled in the study, from September 2003 until December 2004. They were followed up for 32 weeks.
Mastectomy, both radical and conservative and axillary lymph node clearance, was the standard surgery applied for operable
breast carcinoma in this series. Clinical examination was followed by testing for the shoulder complaint by measuring maximal protrusion at the inferior scapular angle, scapular stabilization and the lift-off tests. Approved physiotherapy modalities were then applied, viz: no treatment (randomly chosen 12 patients), passive and active motion
therapy (14 patients), oral
diclofenac sodium (19 patients), local triamcinilone injection (40 patients) and manually applied low intensity
laser therapy (15 patients). Assessment was by determining overall success rate for each intervention modality. Intervention outcome was assessed at 8, 16, and 32 weeks as shown by physical examination using the healthy shoulder as a reference, and by measuring restricted mobility during passive lateral rotation and glenohumeral abduction. "Success rate" was determined separately for each group at the end of the intervention period. The applied surgery was followed by
radiotherapy in 96%,
chemotherapy in 24% and both in 11%. The presenting post
mastectomy symptoms at the shoulder were
pain (100%), shoulder weakness (88%), winging of the scapula (11%) and inability to perform everyday shoulder movements (23%). Evaluation was by overall improvement score. The results were: 14.3% for untreated patients, 43.3% for those treated by motion
therapy, 42% for
diclofenac therapy, 80.7% for local
triamcinolone, and lastly 68% for low intensity
laser therapy. All treatment regimens for shoulder disabilities in those patients gave little long-term advantage, local
steroid injections were the most effective.
Low level laser therapy may augment its effect. It is concluded that all treatment regimens provide little long-term advantage; however, trimcinilone local
injections may be the most useful in terms of
pain relief and improvement in shoulder movement.