From the Guidelines
The patient should be offered physical therapy, including stretching and other exercises, as well as consideration of acupuncture, to manage her bursitis symptoms, as these interventions have been shown to be effective in improving musculoskeletal symptoms in breast cancer survivors 1. The patient's history of breast cancer and frequent occurrence of bursitis in her right shoulder suggests a possible connection between her cancer treatment and musculoskeletal symptoms.
- The American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline recommends assessing for musculoskeletal symptoms and offering interventions such as physical therapy, acupuncture, or referral for rehabilitation 1.
- The guideline also notes that breast cancer survivors may experience difficulties with the ipsilateral upper extremity after surgery, including decreased range of motion, rotator cuff injury, and adhesive capsulitis, which can lead to decreased ability to perform daily activities 1.
- Additionally, systemic therapies for breast cancer, such as aromatase inhibitors, have been associated with the development of musculoskeletal symptoms, including arthralgias and myalgias, which can be severe enough to lead to treatment discontinuation 1.
- However, physical therapy and exercise have been shown to be effective in managing these symptoms, with a prospective cohort study demonstrating a 20% decrease in aromatase inhibitor-associated pain with participation in an intensive exercise regimen 1.
- Acupuncture has also been demonstrated to result in a statistically significant improvement in aromatase inhibitor-associated symptoms 1.
- Therefore, a comprehensive approach including physical therapy and consideration of acupuncture, as well as management of any underlying lymphedema or other musculoskeletal issues, is recommended to improve the patient's symptoms and quality of life.
From the Research
Bursitis and Breast Cancer
- Bursitis of the shoulder can be a significant cause of breast and chest wall pain, often overlooked as a cause of breast pain 2.
- A study found that 22.3% of patients presenting with breast/chest pain were diagnosed with shoulder bursitis, and 83.5% of treated patients had complete relief of pain 2.
- The most commonly associated factor with the diagnosis of bursitis was a history of previous mastectomy, present in 27.2% of cases 2.
Risk Factors for Shoulder Conditions
- Repetitive overhead activity is a common risk factor for subacromial pain and rotator cuff tendinopathy 3.
- Age, underlying anatomic and biomechanical factors, and the presence and degree of tendon tears can influence the management of rotator cuff conditions 3.
- Mastectomy and breast reconstruction are major risk factors for adhesive capsulitis of the shoulder, a common problem after breast cancer treatment 4.
Management and Rehabilitation
- Management of rotator cuff conditions typically starts with conservative care, such as physical therapy, anti-inflammatory drugs, and injection therapies 3.
- Rehabilitation for breast cancer includes physical exercise, manual techniques for pain relief, and physical therapy, with a focus on improving the quality of life and increasing the range of movement in the shoulder on the operated side 5.
- Early diagnosis and proper treatment are essential for patients with risk factors for adhesive capsulitis, such as age 50-59 years and mastectomy 4.