MastectomyThere are many muscle groups that attach to the shoulder girdle and have different directions of pull. If one area becomes shortened or spasmed it will make the other areas work harder to counter the force in the shortened or spasmed direction. Then those secondary areas will also start to shorten and/or tighten in compensation to the original force. As you can imagine, this can become a domino affect until all of the muscle groups around the shoulder become shortened and rigid. Then you will see a frozen shoulder type of pattern. As scars form they tend to pull and twist into themselves, pulling in the tissues around them to the central scar area. Post mastectomy this force will pull the fascia of the anterior shoulder and the bony shoulder girdle down and forward. The anterior muscles will all shorten to this new resting length. Conversely the muscles on the back of the shoulder girdle will be stretched. Muscles do not like to be longer then their resting length, so they will contract to get the fibers back to the right length. Over time this chronic contraction will fatigue the muscles and they will start forming adhesions within the muscle. At this point the patient will feel varying degrees of pain and dysfunction in their shoulder complex. Often I have seen the patient complaining of pain in the back and top of the shoulder. They may feel a pull in the front of their shoulder in the scar tissue and even the pectoralis muscles may feel sore and tight. These mechanical changes will affect the range and function of the shoulder complex, so the patient will often note a change in her ability to perform daily activities.

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