Saving shoulder function after breast cancer surgery

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For some breast cancer survivors, the battle continues long after they are free of disease. Pain and stiffness continue to hamper their movements years later.

Now, researchers at the University of Michigan are trying to determine the best options to preserve shoulder function.

Forty-five-year-old Tina Harrison has had a lot of experience with cancer over the past five years.

"My sister had breast cancer, I went through everything with her down in Florida," she said. "My mom had ovarian cancer. My grandmother had breast cancer. Came back from my sister's cancer surgery and went to my doctor."

Harrison chose to have a preventive double mastectomy, and that is when doctors found her cancer. Five years later, she still feels the effects of surgery.

"Stiffness, yes. Pain, yes. It was all there," she said.

Researchers are studying long-term shoulder function in breast cancer survivors. Women who seem to lose the most function have undergone a procedure called a lat flap reconstruction.

"They basically take muscle off the back, move it to the chest wall and use that to house the permanent implant," Michigan School of Kinesiology Dr. David Lipps said.

Doctoral student Josh Leonardis motivates Harrison to push against a robotic device, measuring how the muscle reacts. Harrison did not have a lat flap reconstruction but still has shoulder pain.

Lipps says the goal is to identify which patients would benefit from earlier physical therapy.

"For functional tasks like lifting a bag of groceries off the ground or moving your arm around back to hook a bra," he said.

Those are movements that can restore quality of life after cancer.

Lipps said he was finishing his training in 2013 when his mother, Marsha, was diagnosed with breast cancer and needed radiation.

Lipps said his interest in radiation therapy and muscle tissue evolved to the work he does today, studying surgical outcomes in breast cancer survivors.

MEDICAL BREAKTHROUGHS
RESEARCH SUMMARY
TOPIC: SAVING SHOULDER FUNCTION AFTER BREAST CANCER SURGERY
REPORT: MB #4594

BACKGROUND: After breast cancer surgery some women experience numbness, swelling, weakness, or tingling in the arm and shoulder area on the same side of the body on which surgery was done. These problems are more likely to happen after mastectomy surgery and less likely to happen after lumpectomy. The possibility for arm and shoulder problems depends quite a bit on whether any lymph nodes were removed during surgery and if so, how many were removed. Lymphedema is a condition that can happen after breast cancer surgery. Research has shown that between 5% and 25% of women develop some lymphedema after breast cancer surgery. Lymphedema is a build-up of lymph fluid in arm tissue, which causes swelling. Edema is the medical term for swelling. Lymph fluid normally drains from body tissue through the lymph nodes and lymph channels. If some lymph nodes and channels are removed or damaged during surgery, lymph fluid doesn't drain properly and collects in the tissue near the surgery site. Lymphedema can cause other symptoms such as tingling, numbness, stiffness, and weakness. Still, those problems can happen after breast cancer surgery even without lymphedema. (Source: https://www.breastcancer.org/research-news/20080909)

TREATMENT: During latissimus dorsi flap reconstruction surgery, an incision is made in your back near your shoulder blade. Then, an oval section of skin, fat, blood vessels, and muscle is slid through a tunnel under the skin under your arm to your chest and formed into a breast shape. The blood vessels are left attached to their original blood supply in your back. If any blood vessels do have to be cut, they are matched to blood vessels in your chest and carefully reattached under a microscope. It can take about 4 weeks to recover from latissimus dorsi reconstruction surgery. (Source: https://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous/lat-dorsi/what-to-expect)

NEW RESEARCH: David Lipps, PhD, Assistant Professor, Movement Science at the University of Michigan School of Kinesiology talks about a way to measure stiffness, "We're really interested in studying the mechanisms of why women are impacted by breast cancer surgeries. We have a variety of techniques for doing this. One technique we have is a robot assisted measure of shoulder stiffness, so we can actually measure globally how all the muscles around the shoulder impact how someone is able to stabilize their shoulder. And then we have some cool ultrasound techniques in the lab, ultrasound elastography, where we can measure specifically how the stiffness of different individual muscles changes following different breast cancer managements." (Source: David Lipps, PhD)