Frozen Shoulder After Mastectomy or Radiation

Weeks or months after breast surgery or radiation, the shoulder on the treated side stops going where you send it. Pushing harder only hurts. Reaching for a seatbelt or a high shelf becomes the test you fail.

MedlinePlus defines frozen shoulder as a condition in which the shoulder is painful and loses motion because of inflammation. The tissue capsule around the joint becomes inflamed. Then it no longer lets the joint move freely.

The pattern feeds itself. Pain can be bad enough that you stop moving the arm. Not moving it causes more stiffness, and more loss of motion. Reaching overhead or behind your back gets harder. The shoulder tightens because you are protecting it.

MedlinePlus lists the recognized risk factors. Shoulder injury or surgery is one. So is breast surgery. So are diabetes, thyroid problems, and hormonal changes such as menopause. Most cases have no cause anyone can find. Women aged 40 to 70 are affected most often, and that group overlaps heavily with breast cancer patients.

This is worth saying plainly. The National Cancer Institute does not publish a page on adhesive capsulitis after breast cancer treatment. Its relevant material covers lymphedema and general post-treatment effects. So the guidance below comes from two other places. One is general frozen shoulder care, from MedlinePlus. The other is the American Cancer Society's exercise guidance after surgery, which covers stiffness broadly rather than diagnosed frozen shoulder. No federal source says how often frozen shoulder follows mastectomy or chest wall radiation. If someone quotes you a precise percentage, ask where it came from.

The American Cancer Society explains that exercises help decrease side effects of your surgery. They also help you get back to your usual activities. Pain and stiffness after surgery can limit arm and shoulder movement. That affects daily tasks like dressing, bathing, and combing hair. Without exercise, ACS warns, you may end up with weakness and limited movement of your arm and shoulder. Regular movement matters even more if you are having radiation therapy, ACS notes. It helps you keep flexibility over the long term.

Here are ACS's general guidelines for these exercises.

• Do not start any of these exercises without talking to your doctor first.
• Move slowly, only until you feel a gentle stretch.
• Hold each stretch for 5 seconds.
• Repeat each exercise 5 to 7 times, twice daily.
• Exercise when your muscles are warm, such as after a shower.
• Never bounce or make jerky movements.

ACS sets a clear checkpoint. If you have not regained full use of your arm within 3 to 4 weeks after surgery, ask for guidance from a physical therapist or occupational therapist.

MedlinePlus explains how it is diagnosed. Usually a clinical examination is enough, showing that the shoulder does not rotate fully. X-rays may rule out arthritis or calcium deposits. Sometimes an MRI shows inflammation. But these imaging tests are usually not needed to diagnose frozen shoulder.

MedlinePlus states that pain is treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and steroid injections. Physical therapy improves motion. If these approaches fail, your doctor may recommend shoulder arthroscopy, a keyhole operation to remove scar tissue and release ligaments.

On timing, MedlinePlus is realistic. Complete recovery may take as long as 9 months to a year. Untreated cases often improve within 2 years. That is slow, but for most people it is not permanent.

Stiffness that develops gradually and eases with movement is expected. Some changes are not. Those need to be looked at, not exercised through.

• Call your care team the same day if the arm or chest wall on the treated side turns red, feels warm, and is tender or swollen. NCI's lymphedema guidance calls these cellulitis signs and says to ring your doctor right away, above all with a temperature of 100.4°F (38°C) or higher.
• Call your care team the same day if swelling or tenderness turns up out of nowhere, which the American Cancer Society lists as a reason to contact your provider rather than push on with exercises.
• Call your care team within a day or two if the tightness keeps building despite doing your exercises as instructed.
• Call your care team within a day or two if the movements you were prescribed have become difficult, or you still do not have full use of the arm 3 to 4 weeks after surgery. ACS sets that as the point to ask for a physical or occupational therapist.

The two can look similar, and they can happen together. NCI describes lymphedema as swelling caused by a buildup of lymph fluid between the skin and muscle. It appears in your hand, arm, or chest, on the side where lymph nodes were removed or damaged. Its symptoms include a heavy, full, or tight feeling where you had surgery or radiation therapy. Others are swelling, numbness or tingling, difficulty moving your arm, and weakness in the arm.

"Difficulty moving your arm" sits on both lists. So do not assume a stiff shoulder is only a joint problem. Ask your team.

• National Cancer Institute — Lymphedema (PDQ), Patient Version: https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-pdq
• MedlinePlus (NIH) — Frozen shoulder: https://medlineplus.gov/ency/article/000455.htm
• American Cancer Society — Exercising After Breast Cancer Surgery: https://www.cancer.org/cancer/types/breast-cancer/treatment/surgery-for-breast-cancer/exercises-after-breast-cancer-surgery.html