Date of Award

2016

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Peggy Mohr

Keywords

Mastectomy -- adverse effects; Shoulder Impingement Syndrome -- rehabilitation; Case Reports

Abstract

Background. Women who undergo mastectomy are almost 6 times more likely to experience shoulder restriction and impairment than patients who undergo breast-conserving surgery. Many women in the U.S. will develop invasive breast cancer over the course of their lives. The purpose of this case study is to review the rehabilitation plan for a patient with shoulder dysfunction and a history of surgical intervention for breast cancer.

Case Description. The patient was referred to physical therapy with complaints of pain in the right shoulder and anterior chest which increased with overhead movement. The patient's medical history included a skin graft to the right axilla, right sided lumpectomy, chemotherapy, radiation, and a unilateral right total mastectomy. Examination procedures resulted in reproduction of symptoms during palpation of the mastectomy site and during shoulder impingement tests.

Plan of Care. The interventions performed included scar mobilization, ultrasound, patient education, stretching, and shoulder girdle strengthening. After 8 physical therapy (PT) sessions, the patient reported decreased pain and was able to return to her previous level of function.

Reflection on Practice. This patient demonstrated that, with time and support from health care professionals, psychological acceptance of a diagnosis was promoted. I could have also provided more information to the patient regarding psychological services and to the physician in regards to shoulder dysfunction diagnosis. It is recommended that education be provided to patients immediately after a mastectomy surgery in order to prevent shoulder dysfunction.

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