Shoulder pain, reduced mobility, and functional limitations are common complications following unilateral mastectomy, often leading to long-term disability and an increased risk of secondary shoulder-hand syndrome
Female adults between 30 and 65 years old.
Modified radical mastectomy, or
Breast-conserving surgery with axillary clearance.
Postoperative interval between 4 and 12 weeks before enrollment.
Previously diagnosed shoulder disorders (adhesive capsulitis, rotator cuff tear, fracture/dislocation).
Active or untreated lymphedema Grade II-III.
Ongoing chemotherapy-induced neuropathy causing shoulder dysfunction.
History of neurological or rheumatological disorders affecting the upper limb.
Parallel
Interventions 1. Scapular and Shoulder Exercise Program (Intervention Group) Supervision and Duration • 3 sessions/week • 45-60 minutes per session • Total duration: 8 weeks (24 sessions) • Conducted
Procedure/SurgeryInterventions 1\. Scapular and Shoulder Exercise Program (Intervention Group) Supervision and Duration * 3 sessions/week * 45-60 minutes per session * Total duration: 8 weeks (24 sessions) * Conducted by physiotherapists with ≥5 years of musculoskeletal oncology rehabilitation experience (10). Exercise Components The program consists of five progressive phases: Phase 1: Mobility and Motor Control (Week 1-2) * Pendulum exercises * Active-assisted ROM using pulleys or wand * Scapular clocks and gentle setting exercises * Pectoralis minor and posterior capsule stretching * Deep breathing and thoracic mobilization exercises Phase 2: Early Scapular Activation (Week 2-3) * Scapular retraction with tactile cueing * Serratus anterior low-load activation (wall slides, punches without resistance) * Lower trapezius recruitment in prone position * Active ROM to 120° flexion/abduction Phase 3: Functional Strengthening (Week 3-5) * Resistance-band exercises (yellow to red): * External rotation * Flex
Shoulder Function
Shoulder Function 1. DASH (Disabilities of the Arm, Shoulder and Hand) * Reliable in post-mastectomy populations. * Range: 0 (best) to 100 (worst). 2. Shoulder Range of Motion (ROM) * Measured using a calibrated universal goniometer * Movements: flexion, abduction, external and internal rotation * Three trials averaged for analysis
Secondary out come
Pain Intensity • Visual Analog Scale (VAS, 0-10) at rest and during movement 2. Incidence of Secondary Shoulder-Hand Syndrome (SHS) Diagnosis based on recognized clinical criteria: * Continuous upper limb pain * Diffuse edema of hand/fingers * Stiffness of wrist/hand joints * Trophic skin changes (temperature, sweating, glossy skin) * Reduced grip strength * Symptoms persisting \> 2 weeks Diagnosis will be made by an oncologic rehabilitation specialist. 3. Muscle Strength * Shoulder flexors, abductors, and external rotators * Measured using portable hand-held dynamometry (HHD) * Three trials with 1-minute rest 4. Quality of Life * EORTC QLQ-BR23 (breast cancer-specific module) 5. Shoulder Mobility Patterns * Observed scapulohumeral rhythm * Documented using a standardized clinical checklist
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