Breast Cancer Surgery & Shoulder ROM Loss

The surprisingly high rate of shoulder mobility loss following breast cancer surgery – even with standard rehabilitation – highlights a critical, often underestimated, aspect of cancer recovery. A new study from Japan reveals that over 80% of patients experience significant limitations in shoulder range of motion just one month post-operation, impacting daily activities and overall quality of life. This isn’t merely a discomfort issue; it’s a functional impairment that can hinder a patient’s return to independence.

The challenge of post-mastectomy shoulder dysfunction is rooted in the complex interplay of surgical intervention and the body’s natural healing response. Axillary lymph node dissection, a common component of breast cancer surgery, disrupts lymphatic drainage and can lead to inflammation and fibrosis in the shoulder region. This, combined with post-surgical pain and immobilization, contributes to stiffness and reduced range of motion. While inpatient rehabilitation is standard, this study demonstrates its limitations in preventing significant early decline. The Japanese context is important; healthcare systems and rehabilitation protocols vary globally, but the underlying biomechanics and physiological responses to surgery remain consistent.

What’s particularly noteworthy is the magnitude of the range of motion loss – an average decrease of over 30 degrees in both flexion and abduction. This isn’t a subtle change; it’s enough to make everyday tasks like reaching for items on a shelf, dressing, or even washing hair significantly more difficult. The identification of older age, greater nodal removal, and total mastectomy as key predictors allows for a more targeted approach to care.

The Forward Look: We can anticipate a shift towards more personalized and preventative rehabilitation strategies. Expect to see increased emphasis on pre-habilitation – exercises performed *before* surgery to build strength and flexibility – becoming standard of care. Telemedicine-based exercise programs, already showing promise (as referenced in related EMJ reviews), will likely expand, offering convenient and accessible support for patients in the critical early recovery period. Furthermore, research will likely focus on optimizing pain management protocols and exploring novel therapies, such as early mobilization techniques and targeted massage, to mitigate fibrosis and improve shoulder function. The study’s findings also underscore the need for improved patient education, empowering individuals to understand the risks and actively participate in their rehabilitation journey. Finally, expect to see the development of risk stratification tools, incorporating these predictive factors, to guide clinical decision-making and ensure that patients receive the appropriate level of support to regain full shoulder function and independence.

Reference: Koyama S et al. Factors affecting shoulder joint range of motion after breast cancer surgery: a retrospective cohort study in Japan. Support Care Cancer. 2026;34(2):97. doi: 10.1007/s00520-025-10260-y.