Amy J. Litterini
© 2021 Marissa Paquette
Background and Purpose: Breast cancer treatments may cause late effects of pain, range of motion loss, and activity limitation in the upper extremity (UE). The purpose of this case report was to describe the utilization of soft tissue techniques with instrument assisted soft tissue mobilization (IASTM) in outpatient physical therapy to address decreased UE function and pain for a patient post-surgery, chemotherapy, endocrine therapy and radiation.
Case Description: The patient was a 61-year-old female referred to physical therapy (PT) for restricted mobility and pain in her right UE post-oncologic treatments preventing her from vocation and participating in daily activities. The initial evaluation demonstrated right UE weakness of 4/5 (withstand light resistance), painful right active end-range of motion pulling into the hip and trunk with corresponding right-sided tissue puckering and mottling. The patient received 26 visits over 23 weeks combining manual therapy techniques, IASTM, yoga, a foam rolling program, and therapeutic exercises.
Outcomes: At the recertification at week 23, she demonstrated outcome measure improvements in right UE strength 4/5 to 4+5 (withstand moderate resistance); increased tolerance of UE end-range AROM with decreased reported pain sensation; Quick Disability of the Shoulder Arm and Hand score decrease (27.27/100 to 11.36/100); Numeric Pain Rating Scale decrease (2/10 to 1/10); and Pain Disability Index decrease (2/10 to 1/10).
Discussion: The prescribed treatment plan appeared to be beneficial for this patient. Orthopedic outpatient PT rehabilitation for UE conditions in breast cancer survivors should have consideration to effects of surgical, medical and radiation treatments both locally and systemically. The pursuit of therapists’ continuing education for future treatment considerations of breast cancer survivors post-surgery combined with endocrine, chemotherapy and radiation may enhance efficacy of soft tissue mobilization and therapeutic exercises.
Paquette, Marissa, "Soft Tissue Techniques For Upper Quadrant Range Of Motion And Pain In A Breast Cancer Survivor Following Mastectomy: A Case Report" (2021). Case Report Papers. 126.