Three-dimensional scapulothoracic motion following treatment for breast cancer
Three-dimensional scapulothoracic motion following treatment for breast cancer
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DOI：
10.1007/s10549-008-0240-x
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发表时间：
2009-11-01
影响因子：
3.8
通讯作者：
Sugden, Elaine
中科院分区：
文献类型：
--
作者：
Shamley, Delva;Srinaganathan, Ragavan;Sugden, Elaine
据报道，乳腺癌治疗后肩关节发病率水平各不相同。患者报告疼痛、虚弱、紧绷和功能能力降低。手臂和肩部的正常无痛运动需要肩胛胸关节、盂肱关节、肩锁关节和胸锁关节的活动。在健康的情况下，手臂的抬高伴随着肩胛骨的回缩、侧向旋转和后倾。然而，当肩胛胸运动与盂肱运动不成比例时，可能存在微创伤和长期疼痛。一些针对乳腺癌患者的研究显示，盂肱关节的运动范围有限，我们实验室最近的一份报告显示，作用于肩胛骨的四块关键肌肉的肌肉活动减少。然而，没有研究测量治疗对与盂肱运动相关的三维（3-D）肩胛胸运动的影响。152名接受单侧乳腺癌治疗的妇女被纳入研究。所有患者均填写肩关节疼痛和残疾指数（SPADI）。记录患侧和健侧肱骨和肩胛骨的三维运动学数据。使用随机效应多元回归技术确定运动学数据、SPADI和协变量之间的关联。所有肩胛骨的运动学参数显着改变一侧的乳腺癌幸存者的癌。两种报告的疼痛和功能障碍水平均与运动学改变相关。据报道，手术后长达6年的时间里，疼痛和残疾程度很高。左侧受累的患者报告了更高水平的疼痛，并表现出更显着的肩胛胸功能障碍独立的优势。改变的运动模式是不同的左侧与右侧的影响。左侧受累患者需要被视为具有较高疼痛水平和肩关节功能障碍风险的一组患者。无论是原因还是结果，疼痛报告都伴随着三维肩胛骨功能障碍，这与许多其他肩部疾病相似。
Varying levels of shoulder morbidity following treatment for breast cancer have been reported. Patients report pain, weakness, tightness and reduced functional capacity. Normal painfree motion of the arm and shoulder requires mobility in the scapulothoracic, glenohumeral, acromioclavicular and sternoclavicular joints. Under healthy conditions elevation of the arm is accompanied by scapula retraction, lateral rotation and posterior tilt. However, when scapulothoracic motion is disproportionate to glenohumeral motion, the potential exists for microtrauma and long term pain. A number of studies on women treated for breast cancer have shown limitations in glenohumeral range of movement and a recent report from our laboratory has shown decreased muscle activity in four key muscles acting on the scapula. However, no study has measured the effect of treatment on three-dimensional (3-D) scapulothoracic motion in relation to glenohumeral motion. 152 women treated for unilateral carcinoma of the breast were included in the study. All patients filled out the Shoulder Pain and Disability Index (SPADI). 3-D-kinematic data for the humerus and scapula was recorded during scaption on the affected and unaffected side. The association between kinematic data, SPADI and covariates was determined using random effects multiple regression techniques. All scapula kinematic parameters were significantly altered on the side of the carcinoma in breast cancer survivors. Both reported levels of pain and dysfunction were associated with altered kinematics. High levels of pain and disability were reported for up to 6 years post surgery. Patients with the left side affected reported higher levels of pain and demonstrated more significant scapulathoracic dysfunction independent of dominance. Altered movement patterns were different for left versus right side affected. Left side affected patients need to be considered as a group of patients at risk of experiencing higher levels of pain and showing greater shoulder dysfunction. Whether cause or effect, pain reports are accompanied by 3-dimensional scapula dysfunction which mimics that of many other shoulder conditions.