Amy J. Litterini
© 2018 Andrew Chongaway
Background: Cancer treatments can have late effects on the musculoskeletal, cardiopulmonary, nervous, and integumentary systems. This case report describes comprehensive physical therapy (PT) management of decreased shoulder function for a patient with a history of breast, lung, and tongue cancers treated with surgery, chemotherapy, and radiation. Case Description: The patient was a 71-year-old female referred to outpatient PT for right shoulder and neck pain with the goals to reduce pain and increase functional mobility. Past history included local cancer treatment occurred to the right upper quadrant for multiple cancers. Outcome measures included the Upper Extremity Functional Scale (UEFS), the Numeric Pain Rating Scale (NPRS), range of motion (ROM) assessment and Manual muscle (MMT) strength testing. Interventions included manual therapy, therapeutic exercises, and aquatic therapy. Outcomes: The patient received nine visits of skilled PT. At discharge, she demonstrated improvement in right shoulder flexion active ROM (146 to 155 degrees) and shoulder flexion strength on MMT (4/5 [good] to 4+/5 [good+]). She reported improvements in lifting overhead, though her UEFS score improved minimally (72/80 to 74/80). On the NPRS, her pain decreased (6/10 to 1/10). Discussion: This case report described a comprehensive PT plan for decreased shoulder function in a patient with a history of multiple cancers. Late effects of cancer treatment can have a significant impact on a patient’s ability to complete essential activities of daily living and substantially decrease quality of life. Research has shown PT to be beneficial in mitigating these late effects, and therefore, rehabilitation should be included in the comprehensive care of cancer survivors.
Chongaway, Andrew, "Comprehensive Physical Therapy Management Of A Patient With Decreased Shoulder Function And A History Of Breast, Lung, And Oral Cancer: A Case Report" (2018). Case Report Papers. 99.