Shoulder Exercise Training on Pain, Range of Motion, and Functional Limitations in Women Following Unilateral Mastectomy

Shoulder pain, reduced mobility, and functional limitations are common complications following unilateral mastectomy, often leading to long-term disability and an increased risk of secondary shoulder-hand syndrome. Conventional physiotherapy provides general postoperative rehabilitation but may not adequately address altered scapulothoracic mechanics or psychological factors that contribute to persistent dysfunction. Targeted scapular and shoulder exercises may enhance clinical recovery; however, high-quality evidence supporting their effectiveness remains limited

Inclusion criteria

• Participants must meet all of the following criteria:

• Female adults between 30 and 65 years old.
• History of unilateral breast cancer managed with either:

• Modified radical mastectomy, or
• Breast-conserving surgery with axillary clearance.
• Postoperative interval between 4 and 12 weeks before enrollment.
• Objective evidence of impaired shoulder mobility or function including:

• Reduction of ROM ≥ 15% compared to the contralateral side,
• VAS pain ≥ 3/10 during shoulder movement, or
• DASH functional score > 25.
• Ability to ambulate independently and follow therapist instructions.
• Willingness to commit to the full rehabilitation protocol for 8 weeks.

Exclusion criteria

• Participants will be excluded if they have:

• Previously diagnosed shoulder disorders (adhesive capsulitis, rotator cuff tear, fracture/dislocation).
• Active or untreated lymphedema Grade II-III.
• Ongoing chemotherapy-induced neuropathy causing shoulder dysfunction.
• History of neurological or rheumatological disorders affecting the upper limb.
• Metastatic disease or local recurrence.
• Recent infection, seroma, or unhealed surgical wounds.
• Participation in another physical therapy or exercise program in the past 4 weeks.
• Cognitive impairment or psychiatric conditions interfering with adherence.