this study will be conducted to investigate the effect of scapular mobilization and scapular Proprioceptive neuromuscular facilitation on shoulder dysfunction after latissimus dorsi flap breast reconstruction
age ranged from 40 to 55 years.
All patients were female patients suffering from shoulder dysfunction after latissimus dorsi flap breast reconstruction.
All patients suffering from moderate or severe pain on shoulder joint and limited range of motion that may affect daily activities.
All patients begun the treatment program 3 to 4 weeks after LDF breast reconstruction.
Current metastases.
Neurological deficit affecting the shoulder functioning during daily activities.
Pathology of the shoulder joint including rotator cuff tear adhesive capsulitis and tendinitis.
Pain or disorder of the cervical spine, elbow, wrist or hand.
Parallel
scapular mobilization and scapular proprioceptive neuromuscular facilitation exercises
Other interventionfor scapular mobilization, The patient will be laying on the affected forearm on their back. The therapist is standing before the patient's affected shoulder, placing the index finger of one hand under the medial scapular border, the other hand grasping the superior border of the scapula. The scapula was moved superiorly and inferiorly for superior and inferior glide, and then the scapula is rotated upward and downward for scapular rotation. Second, with the patient was in the same position the physiotherapist put the ulnar fingers under the medial scapular border and distracted the scapula from the thorax. Sets of 10 repetitions were applied performed at a rate of one cycle per 6 s, with a rest interval of 30 seconds between sets. for PNF is applied by a trained therapist in two diagonals, anterior elevation and posterior depression and posterior elevation and anterior depression with 20 repetitions for each diagonal. plus tradional physical therapy.
traditional physical therapy
Other interventionthe patients will recieve the traditional physical therapy program in the form of shoulder Range of motion, stretching and strengthening exercises.
pain intensity
The Visual analogue Scale (VAS) will be used for the measurement of pain. It consists of a line usually 100 mm in length, with anchor descriptors such as (in the pain context) "no pain" and "worst pain imaginable"
shoulder and arm disability
Disability of the arm, shoulder and hand questionnaire will be used to assess shoulder and arm disability. This system gives a percentage disability score of upper limbs where 0 indicates no disability and 100 indicates complete disability. The DASH questionnaire consists of 30 questions assessing the impact of upper limb disability (if any) on activities of daily living. There are also optional sections within the questionnaire examining the effect of their limb function at the work place during sports or when playing musical instruments
shoulder range of motion
The baseline bubble inclinometer will be used to assess shoulder ROM.
scapular upward rotation
The baseline bubble inclinometer will be used to assess scapular upward rotation
scapular downward rotation
The baseline bubble inclinometer will be used to assess scapular downward rotation
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