Breast Cancer: Why Do I Have Arm and Shoulder Pain?

Medically reviewed by Monica Bien, MPA, PA-C on November 5, 2015Written by Kathi Kolb, MSPT on November 5, 2015

One of the most common problems breast cancer patients experience after breast cancer treatment is pain, numbness, and loss of mobility. Virtually every aspect of treatment can result in pain, stiffness, decreased motion, strength, swelling, or sensory changes. The neck, arms, legs, chest, shoulders, hands, feet, and joints can all be affected. Some of these problems may occur immediately, while others may develop over time, even months after initial treatment is done.

Why does this happen? Here are some of the reasons.

1. Surgery

Several types of surgeries may be done for breast cancer, and often, you have to have more than one. These include lumpectomy, mastectomy, sentinel node biopsy, lymph node dissection, expander placement, expander exchange with implant placement, and reconstructive breast surgery. During any of these procedures, the tissues and nerves are manipulated and can be damaged and will likely cause swelling and soreness afterwards. Drains might be inserted for up to a few weeks to help clear away the excess fluid, and the drains themselves are often uncomfortable.

As healing progresses, we develop visible scar tissue. Internally, there may be changes in connective tissue that can manifest as a thickening or a cord-like structure in our armpit or a tightness when we move. We also may feel tired and stressed as we wait for pathology reports, and are probably taking pain medications we don’t normally take which can cause fatigue and dizziness.

All of this is normal, but this is when problems can start. Any time our mobility is limited by surgery for even a few days, we can begin to lose stamina, strength, and range of motion and we may find we need help to get dressed and bathe ourselves. In general, most surgeons allow patients to start gentle arm and shoulder exercises within a few days of surgery. Before you go home from the hospital, make sure you know what your surgeon recommends.

An occupational or physical therapist can teach you how to move and exercise safely. You may not feel up to doing very much, but it’s important to move when you can. At this stage, even gentle range of motion exercises can help keep us from losing too much mobility and prevent us from developing lymphedema.

2. Radiation

Many of us will have radiation therapy within weeks of surgery. It may be internal radiation (brachytherapy), or external radiation. Internal therapy is targeted treatment designed to spare normal, healthy tissue. External radiation is usually given over the whole breast area, and in some cases it will include the armpit (axilla), in daily doses over a period of weeks.

Radiation therapy works by destroying DNA inside the cell and making it incapable of dividing and multiplying. Radiation will affect both cancer cells and normal cells. Cancer cells are more easily destroyed by radiation, while healthy, normal cells are better able to repair themselves and survive the treatment. Unfortunately, this repair process is imperfect. The healing process tends to replace some of the damaged healthy cells with tissue that is not the same as it was originally. For instance, our chest muscles may be repaired with tissue that is more fibrous, and therefore less able to expand and contract like normal muscle tissue. Strands of this fibrotic tissue may also stick together and form adhesions, which comprise a kind of interior scar tissue. The scar lines you see along a healed surgical incision include fibrotic tissue.

This type of interior scar tissue is called radiation-induced fibrosis, and it does not completely go away. But we can learn to stretch it, and to strengthen the surrounding muscles to prevent further problems from developing.

3. Chemotherapy

Because we know that cancer cells multiply rapidly, most chemotherapy drugs are designed to target tissue that grows rapidly. Therein lies the risk for side effects, however, because many types of normal cells also tend to grow and replace themselves quickly. These include the cells that make up our hair, fingernails, and eyelashes, the cells that line our mouths and digestive tracts, and the red and white blood cells that are made in our bone marrow.

Oral anti-hormone drugs like aromatase inhibitors can cause joint pain and reduce our bone density, putting us at risk for developing osteoporosis and fractures. Other chemotherapy agents, especially taxanes, can damage peripheral nerves in our hands and feet. This can cause numbness, tingling, decreased sensation, and pain. These symptoms comprise what is called chemotherapy-induced peripheral neuropathy (CIPN). CIPN in our hands can make it difficult to perform fine-motor tasks like writing, holding utensils, and using a keyboard. CIPN in our feet can affect our ability to feel the ground and keep our balance, thus making us unsteady when we walk. In addition, many of us experience a decrease in normal cognitive function. We forget things, find it difficult to solve simple problems, and feel less coordinated.

All of these side effects can cause us to compensate by using our limbs and trunk in abnormal ways. We are usually not conscious of performing these altered movements, but they can lead to problems in our arms, backs, hips, and shoulders that we do not expect.

What Can You Do?

The first thing you should do is to recognize your symptoms early and to report them to your doctor. Symptoms to take note of include:

  • any pain occurring either at rest or during movement
  • decreased joint motion
  • any weakness, fatigue, or sensation changes
  • decreased ability to perform self-care tasks
  • cording in your armpit or along your arm, which may only appear when you raise your arm.
  • increased swelling in your arm, trunk, chest, or neck

Don’t ignore symptoms. The earlier your symptoms are assessed and treated, the better. Your oncologist should evaluate you, and may find it appropriate to refer you to an orthopedist, a neurologist, or a physical therapist.

It’s important to note that symptoms may not appear for several weeks, months, or even years after you finish initial breast cancer treatment. This is not unusual, but it is a mistake to think that they’ll resolve on their own over time. Arm and shoulder problems are often part of the long-term collateral damage caused by cancer treatment. Any of these symptoms may also signal something that we all dread, such as cancer recurrence or metastases. The same advice applies: Report problems early, get properly evaluated, and get some treatment. You can’t fix a problem that you ignore.

CMS Id: 92212