Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy

Figures & data

Table I. Inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
Unilateral carcinoma of the breast. Treatment protocols: 1) Wide local excision + radiotherapy 2) Wide local excision + axillary radiotherapy + radiotherapy 3) Wide local excision + axillary clearance + radiotherapy	Reconstructive surgery Current or previous history of shoulder complex trauma, surgery, pathology or dysfunction Current or previous history of cervical neuropathy Lumpectomy Lymphoedema

Table II. Demographic and clinical data for study sample (n = 176).

	Descriptive values
Control group
Number	21
Age – mean years (SD)	53.10 (6.09)
Handedness
Left	2
Right	19
Patient group
Number	155
Duration since surgery – mean days (SD)	1143.81 (534.77)
Age – mean years (SD)	61.66 (9.13)
Affected side
Left
WLE	50
Mastectomy	22
Right
WLE	56
mastectomy	22
Handedness
Left
WLE	11
Mastectomy	6
Right
WLE	98
Mastectomy	39
missing	1
Dominant side affected
Yes	79
No	75
Missing	1
Chemotherapy
Yes	24
No	127
Missing	4
Mastectomy	21
Mastectomy + radiotherapy	12
Mastectomy + radiotherapy + axillary	14
Wide local excision + radiotherapy	60
Wide local excision + axillary radiotherapy + radiotherapy	20
Wide local excision + axillary clearance + radiotherapy	28
Total SPADI score – mean (SD)	168.10 (185.74)

Table III. Two stage, random effects multiple linear regression for associations between scapula internal/external rotation and covariates.

	Coef.	Std. Err.	z	p-value	95% CI
Side affected (left)	17.69835	5.737425	3.08	0.002	6.453198	28.94349
Chemotherapy (yes)	−17.38926	7.815886	−2.22	0.026	−2.070404	−32.70812
UT effect	0.0061914	0.0017575	3.52	0.000	0.0096362	0.0027467
SA effect	0.0070949	0.0028003	2.53	0.011	0.0016064	0.0125834
Up/down rot Residuals	0.1946942	0.0139525	13.95	0.000	0.1673478	0.2220406
At/Pt Residuals	0.6427942	0.0144075	44.62	0.000	0.614556	0.6710325
Intercept	19.7621	23.09957	0.86	0.392	-25.51222	65.03642

Dependent variable: scap internal/external rotation affected - unaffected, reference category for treatment was WLE + radiotherapy. Only significant variables shown. Number of observations = 2728, Number of patients = 149, 6 observations dropped due to missing covariates. Log likelihood = −7436.63. Model p-value = 0.000.

Table IV. Two stage, random effects multiple regression for associations between scapula upward/downward rotation and covariates.

	Coef.	Std. Err.	z	p-value	95% CI
Upward arm movement	−0.5263677	0.1575948	−3.34	0.001	−0.8352477	−0.2174876
Humeral elevation	0.0196792	0.0028419	6.92	0.000	0.0141092	0.0252492
Side affected (left)	−3.822779	1.612783	−2.37	0.018	−6.983776	−0.6617822
PM effect	−0.0122696	0.0041855	−2.93	0.003	−0.020473	−0.0040661
SA effect	0.0110035	0.0039594	2.78	0.005	0.0032432	0.0187637
Int/Ext rot Residuals	0.3615268	0.0258706	13.97	0.000	0.3108214	0.4122322
At/Pt Residuals	−0.2983994	0.0254423	−11.73	0.000	−0.3482654	−0.2485334
Intercept	−5.851908	6.497204	−0.90	0.368	−18.58619	6.882377

Dependent variable: scap upward/downward rotation affected - unaffected, reference category for treatment was WLE + radiotherapy. Only significant variables shown. Number of observations = 2728, Number of patients = 149, 6 observations dropped due to missing covariates. Log likelihood = −8041.82. Model p-value = 0.000.

Table V. Two stage, random effects multiple regression for associations between scapula anterior/posterior tilt and covariates.

	Coef.	Std. Err.	z	p-value	95% CI
Upward arm movement	0.2815034	0.1188529	2.37	0.018	0.048556	0.5144508
Spadi Pain effect	0.0477709	0.0231911	2.06	0.039	0.0023171	0.0932247
Spadi disab. Effect	−0.0490682	0.0221916	−2.21	0.027	−0.092563	−0.0055733
Wleaxcl Treatment	9.178385	4.501797	2.04	0.041	0.3550238	18.00175
SA effect	0.0096405	0.0029959	3.22	0.001	0.0037688	0.0155123
Int/Ext rot Residuals	0.6787733	0.0151915	44.68	0.000	0.6489985	0.708548
Up/down rot Residuals	−0.1697199	0.0144681	−11.73	0.000	−0.1980768	−0.141363
Intercept	−7.209109	9.02434	−0.80	−0.424	−24.89649	10.47827

Dependent variable: scap anterior/posterior tilt affected - unaffected, reference category for treatment was WLE + radiotherapy. Only significant variables shown. Number of observations = 2728, Number of patients = 149, 6 observations dropped due to missing covariates. Log likelihood = −7362.99. Model p-value = 0.000.

Figure 1. Mean scapula internal/external rotation plotted against humeral elevation and depression for mastectomy and wide local excision (WLE) patients. Arrow represents direction of external rotation.

Figure 2. Mean scapula upward/downward rotation plotted against humeral elevation and depression for mastectomy and wide local excision (WLE) patients. Arrow represents direction of upward rotation.

Figure 3. Mean scapula posterior/anterior tilt plotted against humeral elevation and depression for mastectomy and wide local excision (WLE) patients. Arrow represents direction of posterior tilt.