At all times, you should rely on the expert judgment of your medical advisor.
Shoulder care after surgery for breast cancer.
Stiffness of the shoulder may occur following breast or armpit, otherwise known as axillary surgery, it is therefore important that you regain use of your shoulder as soon as possible after your operation.
This can be achieved through a combination of exercise, massage, and by using your arm normally for daily activities, both at work and at home.
Shoulder movement is improved by doing exercise, as it reduces stiffness and prevents your skin and muscles from becoming tired.
The exercises shown in this video should be used as a guide. Other exercises may be recommended by your physiotherapist or your doctor.
Always do your exercises within your comfort limits.
Stretching and pulling under the armpit are quite normal. If you are experiencing significant pain whilst doing these exercises, speak to your physiotherapist, breast care nurse, or doctor.
The aim of these exercises is to increase movement but also allow time for healing. Do not do the exercises more than recommended or above shoulder height, as this may cause pain or oozing from the wound or drain site.
On the first day after your surgery, it is good to get up and sit out of bed and go for a walk.
Placing a small pillow or rolled towel behind your lower back when sitting helps to keep you upright.
You may place a small pillow on the side of your chest wall for comfort when you are sitting or sleeping but always remove this when you are walking.
Remember to keep your back straight and your shoulders back when you sit or stand. Stand tall when you walk.
The following exercises can be done in sitting in a chair, lying or on the bed, or standing.
Exercise 1.
Take five deep breaths in through your nose and breathe out through your mouth. Then breathe in and cough, supporting the surgical site with the palm of your hand or a small pillow.
Exercise 2.
Repeat each of the following movements five times in order: bend and straighten your elbow, open and close your hand, move your wrist backwards and forwards, place your palm up and palm down, and then bend and straighten your elbow again.
Exercise 3.
Squeeze your shoulder blades together gently and then release. Repeat this exercise five times.
Exercise 4.
Roll your shoulders backwards. Repeat this exercise five times.
Exercise 5.
With your arm resting by your side, point your thumb up towards the ceiling. Keeping your elbow straight, move your arm up in front of you only to shoulder height and within your comfort limits. Return your arm to the resting position. Repeat this exercise five times.
Exercise 6.
With your arm resting by your side, point your thumb up towards the ceiling. Keep your elbows straight. Move your arm out to the side only to shoulder height and within your comfort limits. Return your arm to the resting position. Repeat this exercise five times.
Complete each of these exercises five times and repeat the exercise program four times a day. The aim of these exercises is to increase movement. Do not do the exercises more than recommended or above shoulder height.
If your drain is still in place, please consult your doctor or breast care nurse before commencing these exercises. If you have had any type of breast reconstruction surgery, please consult your doctor or breast care nurse before commencing these exercises.
Remember to breathe during all of these exercises.
In the following exercises, full range of movement is shown. It may be a number of weeks before you are able to achieve your full range of movement. Appropriate progression of these exercises, or other specific exercises that may assist you with returning to daily activities at work and at home, can be discussed directly with your physiotherapist.
Exercise 1.
Stand facing the wall with your arm out straight and your fingers touching the wall. Keep your fingertips on the wall.
Gradually walk your hand up the wall until you feel a comfortable stretch. You may need to move closer to the wall. Keep your fingers and hands on the wall and elbow straight.
Turn your body away from the wall until you feel an increased stretch across your armpit or chest. Hold this position for five seconds while you continue to take slow, deep breaths.
Then turn back to face the wall to reduce the stretch. Repeat this movement five times before returning your arm to the resting position.
Exercise 2.
Stand side on to the wall with your arms straight out and your fingertips touching the wall. Gradually move towards the wall while walking your hand higher up the wall.
Turn your body away from the wall until you feel an increase in stretch across your chest and in the armpit. Hold this position for five seconds while you continue to take slow breaths.
Then turn back to the wall to reduce the stretch. Repeat this movement five times before returning your arm to the resting position by your side.
Exercise 3.
Lie flat on the bed and place your hands behind your head with your elbows out in front of you. Gently try and bring your elbows out to the side and down towards the pillow.
Hold this position for five seconds while you continue to take deep breaths. Repeat this exercise five times.
Exercise 4.
Lie flat on the bed, holding on to a stick or another straight object such as a long ruler, with your arms down by your side.
With your elbows straight, slowly lift up both arms and bring the stick over your head, or as far as you can go within your comfort limits. Return to the resting position and repeat this exercise five times.
Complete each of these exercises five times and repeat the exercise program four times a day. You should continue to do these exercises for six to twelve months after your surgery.
Massage
Begin arm massage seven days after your surgery. Begin scar massage only after the wound dressing has been removed and healing has occurred, usually a minimum of two weeks after your surgery.
Arm massage
Using the flat of your hand with a constant firm pressure, massage from the elbow to the armpit and across the chest. Repeat this movement for one minute once a day. Do not massage towards the hand and fingers. This can be started seven days after surgery or after any dressings or drains in the axilla have been removed.
Scar massage
Check with your physiotherapist, breast care nurse, or doctor if you have had any type of reconstruction operation, or if you are not sure if the area has healed sufficiently before beginning scar massage. The area may be painful or sensitive at first. You can use cream or oil to make the area easier to massage. Both massage techniques can be carried out by yourself or a support person.
Using the flat of your hand with a constant firm pressure, move your fingers in a circular motion across the scar.
Commence the movement at the outer edge of the scar, moving towards the middle of your body.
The scar may be sensitive at first but will become less tender.
You can adjust the pressure of your massage as it becomes less sensitive.
Concentrate on any tight bands or hard nodules of the scar tissue. Repeat this movement two minutes twice a day.
If you have any concerns or are unsure about anything in this video, speak to your physiotherapist, breast care nurse, or doctor. Westmead Breast Cancer Institute also produces shoulder care fact sheets which can be found on the BCI website.
