Prehabilitation Before Lumpectomy Can Prevent Loss of Range of Motion

Abstract

Case Diagnosis: On intake exam, patient reported twenty year history of shoulder pain and history of bilateral subacromial bursitis . On the day of the exam, she rated her left shoulder pain (ipsilateral to breast cancer) at 2/10. Physical exam showed tenderness over left subacromial bursa, pain with resisted shoulder abduction and external rotation and ROM limited 120 degrees or less bilaterally. Case Description: Here, we report the case of a 73 year old woman with a 20 year history of bilateral subacromial bursitis and left shoulder pain who began an independent daily shoulder exercise regimen as instructed by a physiatrist 2.5 weeks prior to left sided lumpectomy for breast cancer, and continued the exercises following the operation. One month post-surgery, physical exam revealed no loss in range of motion (ROM) in flexion and abduction of the left and right shoulders. Patient reported intermittent pain, manageable with NSAIDs, which started only after tamoxifen use. Discussion: Decline in physical functioning such as loss of ROM, decreased strength, and pain following surgery for breast cancer is a well-documented phenomenon associated with difficulties in performing activities of daily living (ADL). Studies have shown that rehabilitation interventions during treatment period following breast cancer surgery result in improvements in shoulder and arm function; however, no study to date investigated the effectiveness of interventions initiated before surgery (prehabilitation) for breast cancer. Conclusions: A daily exercise regimen prior to and following lumpectomy for breast cancer may prevent the development of shoulder dysfunction that is often reported in the cancer treatment period.