Mastectomy after breast cancer is usually accompanied by shoulder dysfunction which interferes with the daily life activities of the patients and causes physical and psychological impairments.
This study aims to assess the impact of strength and stabilization exercise on scapular muscles activation pattern after mastectomy.
Post-mastectomy female subjects.
Age between 35-55 years.
All patients have shoulder dysfunction (three months to four months post mastectomy).
Participants who have rheumatoid arthritis.
History of trauma or injuries.
Neurological deficits (stroke, Parkinsonism).
History of surgery on involved shoulder.
Parallel
Proximal stabilization exercises
Other interventionPatients will receive Scapular mobilization in five manners, superior glide, inferior glide, up-ward rotation, down-ward rotation, and distraction. Each mobilization will be done ten times. A thirty second break will be given between each set. Also scapular strengthening exercises composed of diagonal two (D2) flexion pattern to augment the upper, middle, lower, and serratus anterior muscles' activity level. To activate upper trapezius muscle, shoulder shrug exercise will be used. To activate serratus anterior muscle, Wall slide exercise will be used. Scapular retraction exercise for rhomboids and middle trapezius activation will be done. Strengthening exercises will be performed using weights were initiated with two sets of ten repetitions, beginning with a weight of 0.5 kg and progressed to 0.75, and1kg, it will be applied 5 days per week for 6 weeks
Conventional physical therapy
Other interventionPatients will receive shoulder joint mobilization, posterior capsular stretching, and ROM exercises in form of Codman/pendulum exercise. To mobilize the shoulder joint, distraction of the glenohumeral joint, posterior glide and caudal glide will be performed to the patients in a supine lying position at a frequency of two to three oscillations/second for one to two minutes. Every direction was repeated three to four times. At the resting position rhythmic oscillations grade I and II will be applied. In posterior capsule stretching each stretch will be repeated ten times for 20 seconds, between each stretching a 30-second break will be given. Pendulum exercise will be demonstrated to the patient at first, then they will performed it in the forward-backward direction, side-to-side direction, and circular pattern, for two to three minutes in each direction, it will be applied 5 days per week for 6 weeks
EMG Muscle Activation Amplitude
Surface electromyography (sEMG) will be used to assess the activation patterns of scapular and rotator cuff muscles during functional tasks, such as shoulder flexion, abduction, and external rotation. The sEMG assessment will be conducted using a wireless sEMG system with a sampling rate of 2000 Hz and a bandwidth of 20-500 Hz. Pre-gelled, disposable, self-adhesive Ag/AgCl electrodes will be placed on the muscle belly according to SENIAM guidelines, with an inter-electrode distance of 20 mm. (serratus anterior, upper and lower trapezius, supraspinatus, and infraspinatus) during functional tasks.
Shoulder pain and disability index (SPADI)
It is a self-administered questionnaire that was found to be both sensitive and reliable. It contains thirteen items, which assess two domains (pain and disability). The patient circled the best number that reflected their ache or impairment on a scale from 0 to 10, which has an 8- items subscale to evaluate disability and a fiveitems subscale to measure pain. To calculate a final percentage score for assessing shoulder dysfunction, the scores from the two aspects were averaged
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Ahram Canadian University
Lead sponsor
Benha University
Collaborator
