Breast Cancer Awareness: Shoulder Pain

Breast cancer is the most common cancer among women in the United States (other than skin cancer). But millions of women are surviving the disease thanks in part to early detection and improvements in treatment.

Shoulder pain in breast cancer survivors is a common condition that should not be ignored. Early detection and treatment are important in preventing long-term complications.

Dr. Eric M. Wisotzsky is the Chief of Rehabilitation Medicine and Director of the Cancer Rehabilitation Program at MedStar National Rehabilitation Health Networks. He is also an Assistant Professor of Rehabilitation at Georgetown University Medical Center.

Many breast cancer survivors who have had surgery, chemotherapy and radiation report shoulder pain especially when lifting their arm overhead. What might be the problem?

Shoulder problems are extremely common after breast cancer treatment. Up to 68% of breast cancer patients may experience shoulder pain and/or restricted shoulder motion. There are two common causes of these symptoms.

  • Inflammation
    • Compression of one or more of the rotator cuff tendons is also called tendinitis. Breast cancer patients are prone to get this due to muscle tightness that can occur after surgery or other treatments, especially radiation.
    • In addition, poor posture may contribute to the tendinitis. Studies have shown that alterations in women’s posture after breast surgery can lead to tendinitis of the shoulder. Typically, this type of pain is worse when lying on the shoulder, which can explain the pain at night. The tendon often can become compressed when lifting the arm overhead, which is painful.
  • Frozen Shoulder
    • This condition involves a very stiff shoulder which may or may not be painful. Not moving the arm enough after breast cancer treatment can sometimes lead to this problem. In addition, radiation can add to this stiffness.
  • In terms of treating this problem, seeing a physician who can correctly diagnose the problem is the critical first step.
  • This problem should be addressed by a physician comfortable with the non-surgical management of shoulder problems, such as a physiatrist (a physical medicine and rehabilitation doctor).
  • The physiatrist will talk to you and examine your shoulder to determine the cause of pain.
  • Imaging such as an x-ray or MRI may be ordered to help with the diagnosis and to get a good look at the anatomy of the shoulder.
  • In addition, many physiatrists can use ultrasound in the office to look at your tendons to visualize the extent of the problem.
  • Once the diagnosis is clear, a physician can develop a comprehensive rehabilitation plan to restore your shoulder health.
  • This typically would include a specific physical or occupational therapy program, ideally with a therapist that is experienced in working with breast cancer patients.
  • This program would include improving range of motion, stretching and strengthening shoulder muscles, and restoring appropriate posture.
  • The physician may also prescribe medication, such as an anti-inflammatory.

What if physical therapy doesn’t help?

  • If the symptoms do not completely resolve, the physician may recommend a “cortisone” injection, which can be very helpful
  • This injection can even be done using ultrasound guidance to ensure the medication is devliered to the correct target
  • In refractory cases of frozen shoulder, sometimes a doctor will take the patient to the operating room and while the patient is asleep, gently break the adhesions so the shoulder moves better. This is called “manipulation under anesthesia”.

Shoulder discomfort after breast cancer treatment is extremely common and is not likely to be a sign that your cancer has spread or returned, however it is always important to inform your oncologist of any new pain symptoms.

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