Arm and Shoulder Problems after Breast Cancer

Do you experience pain, stiffness, and limited range of motion after your breast cancer treatments? Even though you maybe had “only” a lumpectomy and not a mastectomy? If you experience ongoing symptoms after your surgery, you are not alone. 

When we go through breast cancer treatments, most of us are told about the risk of developing lymphedema (see our blog on this topic). In this blog post, we would like to focus on some of the lesser talked-about, yet frequently occurring ways breast cancer treatments can impact arm and shoulder function.

The way our breasts, our chest muscles and our shoulder joints interact is something we don’t usually think about, until this balance is disrupted with breast cancer treatments.Our shoulder is a complex joint that is responsible for a variety of tasks, including reaching overhead, lifting and carrying objects, and pushing and pulling.

After breast cancer treatments, women may experience pain, limitation of movement and stiffness in the arm and shoulder on the side of the surgery, as well as aching on the side of their trunk. This can make it difficult to do everyday activities such as reaching up to get something out of a cabinet or putting on a shirt.  Some contributing factors contributing might be:

• Changes in your posture. This is especially true when you had a unilateral or bilateral mastectomy. The incisions can be tight and painful, causing women to keep their shoulders rounded and flexed forward.
• Radiation therapy can lead to tissue fibrosis, which can limit range of motion and lead to feelings of tightness.
• Removal of lymph nodes from the armpits, either in the form of radical dissection (i.e. all are removed) during mastectomy or sentinel biopsy (i.e. only some are removed) with a lumpectomy, can damage the nerves that travel through the armpit into our arm and hand.
• Our not-so-great posture going into treatments. Most of us spend the majority of our days sitting on our computers or otherwise in the forward-flexed position, and may have limited range of motion going into treatments.

If you experience stiffness, loss of mobility and pain after your treatments, there are some things you can do to help:

• Ask for a referral to a Physical Therapist specializing in breast cancer. You may even benefit from a referral if you had a lumpectomy instead of a mastectomy. Remember that symptoms can occur months and even years after treatments, and it is never too late to get that PT evaluation.
• Ask for a referral to a Physiatrist, especially if you have a pre-existing shoulder condition. A Physiatrist is a doctor specializing in rehabilitation, and those trained in the rehabilitation of women with breast cancer can help prescribe the right exercises for you. 
• Tell your doctor about any difficulty reaching overhead, dressing or washing your hair. When we are in the doctor’s office it is sometimes hard to find the time to discuss the “smaller” things, and your doctor may not ask you for symptoms. But exercises and PT can make a huge difference after breast cancer treatments, and we encourage you to try, as long as your doctor approves!
• If you have a lot of nerve pain, such as tingling and a “pins and needles” sensation, ask your doctor if medication is right for you. There are  medications such as Gabapentin that can help with this type of pain.
• Stay physically active as much as possible. Physical activity has been shown to improve quality of life and survival in breast cancer patients.