Shoulder Pain and Mobility Issues After Breast Cancer

It can seem surprising that many women experience shoulder/mobility issues after breast cancer treatment. At first glance, shoulders seem distant from breasts and there is no immediately obvious connection. However, it turns out that shoulder pain, stiffness, or limited range of motion are very common after breast cancer surgery and/or radiation therapy.

Surgery-related Causes of Shoulder Pain

For most women, breast cancer surgery involves at least some action in the axillary/under arm area. Many women need only a sentinel node dissection, which is less invasive than a full axillary node dissection. If the sentinel node (or other lymph nodes) contain cancer cells, then a full axillary node dissection is necessary. It used to be that a full axillary dissection was the standard treatment, but most women now first have a sentinel node biopsy to determine if the larger surgery is needed. Some breast reconstruction — especially those surgeries that involve moving tissue — may also result in shoulder issues.

Nerve Damage and Dysesthesia

The nerves that control our hands and fingers go down our arms and travel through the axilla. If these are damaged by surgery or radiation, the result is pain. This common nerve pain feels like sudden, intense, stabbing pain in your underarm, arm, or even hands. It lasts only moments, but is erratic and unpredictable. As the nerves begin to heal from surgery, there can be a resurgence of this pain. The medical term for this type of pain is called dysesthesia.

Stiffness and Diffuse Pain

More common than nerve pain is stiffness and diffuse pain. I have read estimates that up to 60% of women with breast cancer experience some degree of shoulder discomfort. A common cause is the limited range of motion that most of us experience immediately after surgery. We are given exercises, remember the crawling up the wall one, but not everyone does them as often as could help. Additionally, we are given instructions about what not to do; we are limited in what we can lift and the physical exercise in which we can engage. Those directions are variable, depending on the kind of surgery. Women who undergo breast reconstruction are going to be much more limited in recovery than those who have a wide excision. If we don't pretty quickly regain our usual range of motion (ROM), more stiffness or even frozen shoulder and rotator cuff issues can result.

Lymphedema

Lymphedema can also contribute to the development of shoulder pain. One statistic is that up to 70% of women with lymphedema experience some sort of shoulder pain. This is likely related to the increased weight of a swollen arm, and to the natural tendency to use it less.

Exercise and Physical Therapy

If possible, it can be very helpful to meet with a physical therapist before breast cancer surgery or radiation. There are exercises to do in advance that may reduce the risk of future problems. If it is too late for that, it would still be useful to meet with a physical therapist who can design a personal program to reduce shoulder mobility issues or pain. At BIDMC, we have clinicians who are trained and experienced to work with breast cancer patients with mobility issues. Learn more about BIDMC's Physical Therapy Services. 

Oncologic Physical Therapy

There is a new national certification for physical therapists who have completed training and have experience working with cancer patients and survivors. It is called Board-Certified Clinical Specialist in Oncologic Physical Therapy. If you are seeking a good PT to help with your recovery, ask if s/he has this certification.