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Bordachar D, Mendoza C, Lassaga I, Intelangelo L. Muscle responses during radial nerve-biased upper limb neurodynamic test in asymptomatic individuals: a cross-sectional study. J Man Manip Ther 2023; 31:105-112. [PMID: 35708965 PMCID: PMC10013554 DOI: 10.1080/10669817.2022.2085849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
This laboratory cross-sectional study aimed at explore the muscle response (MR) of the upper trapezius, infraspinatus, biceps brachii and extensor carpi radialis brevis (ECRB) during the radial nerve-biased upper limb neurodynamic test (RN-ULNT) in healthy participants. Myoelectric activity was stage-by-stage recorded during two sequencing variants of the RN-ULNT: S1, in which elbow extension was the last movement; and S2, in which wrist flexion was the last movement. Final elbow and wrist joint angle and sensory response (SR) in five zones (Z1-Z5) were also registered. MR was qualitatively categorized as 'absent' (No-MR), 'true' (TMR) or 'uneven' (UMR). In both sequences, significant increases in muscle activity occurred mostly during shoulder abduction and elbow extension (p ≤ 0.009). Also, elbow extension but not wrist flexion increased the activity of the ECRB muscle (p ≤ 0.009). S2 showed significantly higher upper trapezius (p = 0.04) and biceps brachii (p = 0.036) muscle activity during wrist flexion, and higher report of SR in Z1 and Z4 (p < 0.001) compared to S1. Only the ECRB muscle showed significant differences in the MR type between S1 and S2 (TMR, p = 0.016; UMR, = 0,012). Our results may be useful in the assessment of upper limb musculoskeletal disorders.
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Affiliation(s)
- Diego Bordachar
- Musculoskeletal Research Unit (UIM), University Center for Assistance, Teaching and Research (CUADI), University of Gran Rosario (UGR), Rosario, Argentina
| | - Cristian Mendoza
- Musculoskeletal Research Unit (UIM), University Center for Assistance, Teaching and Research (CUADI), University of Gran Rosario (UGR), Rosario, Argentina
| | - Ignacio Lassaga
- Musculoskeletal Research Unit (UIM), University Center for Assistance, Teaching and Research (CUADI), University of Gran Rosario (UGR), Rosario, Argentina
| | - Leonardo Intelangelo
- Musculoskeletal Research Unit (UIM), University Center for Assistance, Teaching and Research (CUADI), University of Gran Rosario (UGR), Rosario, Argentina
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de la Rosa-Díaz I, Barrero-Santiago L, Acosta-Ramírez P, Martín-Peces-Barba M, Iglesias-Hernández E, Plisset B, Lutinier N, Belzanne M, La Touche R, Grande-Alonso M. Cross-Sectional Comparative Study on Central Sensitization-Psychosocial Associated Comorbidities and Psychological Characteristics in Breast Cancer Survivors with Nociceptive Pain and Pain with Neuropathic Features and without Pain. Life (Basel) 2022; 12:life12091328. [PMID: 36143365 PMCID: PMC9505522 DOI: 10.3390/life12091328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Persistent pain after breast cancer treatment is still under research due to its complex and multifactorial underlying pathogenesis, including phycological factors. Further research is needed to elucidate more information about the factors that cause and perpetuate this pain. Thus, this study defined the influence of psychosocial and psychological factors on breast cancer survivors who report pain and those who do not. The psychosocial factors assessed were those that are associated with a central sensitization process, and the psychological factors were pain catastrophizing, fear of movement, anxiety and depression. Hence, the psychosocial symptom clusters were identified related to the clinical features of pain or to not reporting pain, which may encourage health clinicians to establish a customized biopsychosocial model focused on the management of pain-catastrophizing thoughts and fear of movement. Furthermore, anxiety and depression should be detected early by health professionals and referred to psychologists to be managed. Abstract The frequency of a high Central Sensitization Inventory (CSI) total score and the prevalence of pain have already been established among breast cancer survivors (BCS). However, the psychological factors’ influence based on the clinical features of pain is still unknown, as well as BCS characteristics with no pain. Thus, our main aim was to evaluate the presence of a high CSI total score in BCS with pain and compare it with BCS without pain and to evaluate the influence of psychosocial factors. A cross-sectional comparative study was designed to compare BCS with nociceptive pain (n = 19), pain with neuropathic features (n = 19) or no pain (n = 19), classified by the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). CSI, pain catastrophizing, fear of movement, anxiety and depression symptoms were analyzed and compared among the three groups. The CSI total score was higher in both BCS pain groups compared to BCS without pain, but there were no statistical differences between the pain groups. The same observation was made when comparing pain catastrophizing. The neuropathic feature group showed greater levels of fear of movement, anxiety and depression compared to the no pain group. Thus, CS-psychosocial associated comorbidities and pain-catastrophizing thoughts were more prevalent among BCS with pain, regardless of the clinical features of pain. BCS with neuropathic pain features showed greater psychological disturbances.
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Affiliation(s)
- Irene de la Rosa-Díaz
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
- Physical Therapist in Women’s Health Research Group, Department of Physical Therapy, University of Alcalá, Avenida de León, 3A, 28805 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
| | - Laura Barrero-Santiago
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
| | - Paz Acosta-Ramírez
- Physical Therapy in Torrejón Hospital, Rehabilitation Department, Calle Mateo Inurria, 28850 Madrid, Spain
| | - Marina Martín-Peces-Barba
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
| | - Esther Iglesias-Hernández
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
| | - Bastien Plisset
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
| | - Nicolás Lutinier
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
| | - Margot Belzanne
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Calle Luisa Fernanda, n° 12, Bj Izq, 28023 Madrid, Spain
- Correspondence:
| | - Mónica Grande-Alonso
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Calle Ganímedes, n° 11, 28023 Madrid, Spain
- Instituto de Rehabilitación Funcional La Salle, Aravaca, 28850 Madrid, Spain
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Lorenzo-Gallego L, Arranz-Martín B, Romay-Barrero H, Prieto-Gómez V, Lluch E, Torres-Lacomba M. Changes in Pain Sensitivity in Treatment for Breast Cancer: A 12-Month Follow-Up Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074055. [PMID: 35409738 PMCID: PMC8998435 DOI: 10.3390/ijerph19074055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022]
Abstract
This study aimed to investigate changes in the pain sensory profile of women with breast cancer. Five women with unilateral breast cancer were enrolled. Participants were assessed with direct (quantitative sensory testing, QST) and indirect measures of pain sensitization (self-reported central sensitization inventory, CSI) at baseline (before surgery), 1 week after surgery, and at 1, 6, 9, and 12 months post-surgery. In the event of pain occurrence, the Leeds Assessment of Neuropathic Symptoms and Signs was also used. Nociceptive pain was the predominant pain mechanism in the postoperative period, while an increase in sensitization predominated one year after breast cancer surgery, especially in those participants who had received more treatment procedures. The participants who received more therapies for breast cancer experienced persistent pain and a higher level of sensitization. An assessment protocol including direct measurements (QST) and indirect measurement (self-reported CSI) allows for detecting changes in pain sensitivity, which can be useful for characterizing and/or predicting pain before, during, and up to one year following surgical interventions for breast cancer.
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Affiliation(s)
- Laura Lorenzo-Gallego
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
| | - Beatriz Arranz-Martín
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
| | - Helena Romay-Barrero
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - Virginia Prieto-Gómez
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
- Correspondence:
| | - Enrique Lluch
- Department of Physical Therapy, University of Valencia, 46010 Valencia, Spain;
- Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - María Torres-Lacomba
- Physiotherapy in Women’s Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805 Madrid, Spain; (L.L.-G.); (B.A.-M.); (M.T.-L.)
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Torres-Lacomba M, Prieto-Gómez V, Arranz-Martín B, Ferrandez JC, Yuste-Sánchez MJ, Navarro-Brazález B, Romay-Barrero H. Manual Lymph Drainage With Progressive Arm Exercises for Axillary Web Syndrome After Breast Cancer Surgery: A Randomized Controlled Trial. Phys Ther 2022; 102:6497842. [PMID: 35079831 DOI: 10.1093/ptj/pzab314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/22/2021] [Accepted: 12/22/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to determine the effectiveness of a physical therapist-designed program tailored to axillary web syndrome (AWS) in women after breast cancer surgery. METHODS A prospective, single-center, assessor-blinded, randomized controlled trial was conducted at the Physiotherapy in Women's Health Research Unit of the Alcalá University (Madrid, Spain). Ninety-six women with AWS were assigned to the physical therapy group (manual lymph drainage [MLD] using resorption strokes and arm exercises as if performing median nerve neurodynamic glide exercises with no neural loading; n = 48) or the control group (standard arm exercises; n = 48), with both groups receiving treatment 3 times a week for 3 weeks. Both interventions included an educational component. RESULTS Compared with the control group, the physical therapy group showed significant and clinically relevant improvements in the primary outcome (self-reported pain intensity) at the primary and 3-month follow-ups. Significant and clinically relevant differences between groups were also found in the secondary outcomes (shoulder active range of motion, shoulder disability, and physical and functional aspects of health-related quality of life) at the primary follow-up and in the secondary outcomes as well as the trial outcome index at the 3-month follow-up. No significant differences were found at the 6-month follow-up in either primary or secondary outcomes. CONCLUSION The physical therapy program tailored to AWS was found to be effective for AWS symptoms in women after breast cancer surgery, both immediately after the program and after 3 months. IMPACT To our knowledge, this is the first appropriately designed study to demonstrate the effectiveness of MLD with progressive arm exercises for AWS. Clinicians and health service providers should consider how to provide survivors of breast cancer with AWS the opportunity to participate in physical therapy programs, including MLD with progressive arm exercises. LAY SUMMARY For axillary web syndrome following breast cancer surgery, a physical therapist can design a treatment program including manual lymph drainage and progressive arm exercises, which has been shown to result in reduced pain and improved motion compared with standard arm exercises.
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Affiliation(s)
- María Torres-Lacomba
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Virginia Prieto-Gómez
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Beatriz Arranz-Martín
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Jean Claude Ferrandez
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,Lymphology Consultation, Sainte-Catherine Institute, Avignon, France
| | - María José Yuste-Sánchez
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Beatriz Navarro-Brazález
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Helena Romay-Barrero
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain
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Gala-Alarcón P, Prieto-Gómez V, Bailón-Cerezo J, Yuste-Sánchez MJ, Arranz-Martín B, Torres-Lacomba M. Changes in shoulder outcomes using ultrasonographic assessment of breast cancer survivors: a prospective longitudinal study with 6-month follow-up. Sci Rep 2021; 11:23016. [PMID: 34837018 PMCID: PMC8626448 DOI: 10.1038/s41598-021-02379-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/15/2021] [Indexed: 11/08/2022] Open
Abstract
This study aimed to describe changes in supraspinatus tendon thickness, acromiohumeral distance, and the presence of fluid in the subacromial bursa as measured by ultrasound, as well as shoulder range of motion and strength, perceived shoulder disability, and health-related quality of life in women before and after breast cancer treatment. Women who underwent surgery for unilateral breast cancer who did not suffer from shoulder pain or difficulty performing activities of daily living in the 6 months prior to surgery were included. One pre-surgical (A0) and three post-surgical assessments at 7-10 days (A1), 3 months (A2), and 6 months (A3) after surgery were carried out. The thickness of the supraspinatus tendon on the affected side decreased between post-surgical (A1) and 6-month (A3) follow-up assessments (p = 0.029), although the minimal detectable change was not reached. The active range of motion of the affected shoulder decreased after surgery. Strength changes were observed in both shoulders after surgery. The intensity of shoulder pain increased between post-surgical and 6-month follow-up assessments. Shoulder function was decreased at the post-surgical assessment and increased throughout the follow-ups. Health-related quality of life declined after surgery. A trend of decreasing thickness of the supraspinatus tendon of the affected shoulder was observed. Detecting these possible structural changes early would allow for early or preventive treatment.
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Affiliation(s)
- Paula Gala-Alarcón
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain
| | - Virginia Prieto-Gómez
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain
| | - Javier Bailón-Cerezo
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain
| | - María José Yuste-Sánchez
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain
| | - Beatriz Arranz-Martín
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain.
| | - María Torres-Lacomba
- Physiotherapy in Women's Health (FPSM) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, 28805, Madrid, Spain
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Effect of different postures of the scapular girdle and arm on the pressure pain threshold in the infraspinatus muscle. J Bodyw Mov Ther 2021; 28:276-282. [PMID: 34776153 DOI: 10.1016/j.jbmt.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 07/18/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mechanosensitivity changes and trigger points in the infraspinatus muscle are associated with several painful conditions of the upper limb. The aim of this study was to assess the effect of different postures of the upper quadrant on the pressure pain threshold (PPT) of the infraspinatus muscle. METHODS This was an observational, cross-sectional study. Fifty-four subjects with and without shoulder pain (Asymptomatic subjects = 27, mean age 26.9 ± 4.92 years, BMI 23.73 ± 3.87), (symptomatic subjects = 27, mean age 27.6 ± 3.68 years, BMI 24.35 ± 3.86) were evaluated with a pressure algometer on the infraspinatus muscle belly, in four different positions of the upper quadrant: rest position (P1), passive scapular retraction position (P2), cervical contralateral inclination position (P3), and suprascapular nerve provocation position (P4). The assessed side was randomly chosen and all measurements were taken in sitting position. RESULTS No differences were observed between groups. The within-group analysis showed differences for both factors: "Positions" (F = 69.91; p = 0.001) and the interaction "Positions^Group" (F = 3.36; p = 0.02). The pairwise post-hoc analysis showed differences for the retracted position (P2) compared to others P1 (p = 0.001), P3 (p = 0.001), and P4 (p = 0.001), with higher PPT results achieved on the retracted position. Differences between P4 vs. P1 (p = 0.03) were also observed, with higher values for P4. CONCLUSION Placing the scapular girdle in a passive scapular retraction position significantly reduces the pressure sensitivity at the infraspinatus muscle. Physiotherapists can take into account these results when assessing and treating patients with upper quadrant pain syndromes.
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Prieto-Gómez V, Navarro-Brazález B, Sánchez-Méndez Ó, de-la-Villa P, Sánchez-Sánchez B, Torres-Lacomba M. Electromyographic Analysis of Shoulder Neuromuscular Activity in Women Following Breast Cancer Treatment: A Cross-Sectional Descriptive Study. J Clin Med 2020; 9:jcm9061804. [PMID: 32531893 PMCID: PMC7355794 DOI: 10.3390/jcm9061804] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
Certain secondary effects derived from medical treatment in breast cancer can favor the development of alterations in shoulder biomechanics. To the best of our knowledge, persistent peripheral pain as a key factor for the development of neuromuscular activity impairments has not been analyzed. A cross-sectional descriptive study was carried out. A total of 90 women were included and allocated to three groups: (i) 30 women with persistent peripheral pain after breast cancer treatment, (ii) 30 women without pain after breast cancer treatment, and (iii) 30 healthy women. Surface electromyography was employed to measure the onset and amplitude of the muscle activity of three shoulder movements. Statistically significant differences were found in the neuromuscular activity for all the muscles and shoulder movements among women with persistent pain versus healthy women (i.e., amplitude muscle activity variable p < 0.001). Statistically significant differences were also observed in the neuromuscular activity for certain muscles in shoulder movements among women with persistent pain versus women without pain, as well as between women without pain versus healthy women. Therefore, following breast cancer treatment, women showed alterations in their shoulder neuromuscular activity, which were more significant if persistent pain existed. These findings may contribute to developing a selective therapeutic exercise program that optimizes the shoulder neuromuscular activity in women after breast cancer treatment.
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