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

Breast cancer pain

After treatment for breast cancer, it’s common to experience pain, numbness, and loss of mobility. Virtually every aspect of treatment can result in stiffness, decreased range of motion, or loss of strength. Swelling or sensory changes can also occur.

Parts of your body that may be affected include your:

• neck
• arms and legs
• chest and shoulders
• hands and feet
• joints

Some of these problems may occur immediately. Others may develop over time, even months after initial treatment is done.

Why does this happen? Discover some of the reasons below and how to relieve your pain.

Several types of surgeries may be done for breast cancer. Oftentimes, you need to have more than one. Surgeries include:

• lumpectomy
• mastectomy
• sentinel node biopsy
• lymph node dissection
• reconstructive breast surgery
• expander placement
• expander exchange with implant placement

During any of these procedures, the tissues and nerves are manipulated and can be damaged. This will likely cause swelling and soreness afterward.

Your doctor might insert drains for up to a few weeks to help clear away the excess fluid. The drains themselves are often uncomfortable, too.

As healing progresses, you can develop visible scar tissue. Internally, there may be changes in connective tissue that can feel like a tightness when you move. It may also feel like a thickening or cordlike structure in the armpit, upper arm, or upper torso.

You may feel tired and stressed as you wait for pathology reports. You’re probably also taking pain medications you don’t normally take, which can cause fatigue and dizziness.

All of this is normal, but also when problems can start. Any time your mobility is limited by surgery for even a few days, you can begin to lose stamina, strength, and range of motion. You may find you need help to get dressed and bathe.

In general, most surgeons allow people to start gentle arm and shoulder exercises soon after surgery. Before you go home from the hospital, make sure you know what your surgeon recommends.

Ask for help

If you need help at home, you can ask for some temporary help from a visiting nurse or local home health or home care services. Home health nurses can help you check your drains, surgical wounds, and vital signs for any signs of infection. They can also ensure that your pain is under control. Home care workers can help you with housework, shopping, cooking, and other daily activities, such as bathing and dressing.

Many people 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 in daily doses over a period of weeks. In some cases, it’ll include the armpit (axilla), the collarbone area, or both.

Radiation therapy works by damaging DNA inside the cell and making it incapable of dividing and multiplying.

Radiation will affect both cancer cells and normal cells. It more easily destroys cancer cells. Healthy, normal cells are better able to repair themselves and survive the treatment.

The repair process is imperfect. It tends to replace some of the damaged healthy cells with tissue that isn’t the same as it was originally.

Radiation-induced fibrosis

Your chest muscles may be repaired with tissue that’s more fibrous, and therefore less able to expand and contract like normal muscle tissue.

In addition, strands of this fibrotic tissue may also stick together and form adhesions. These 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. It doesn’t go away completely, but you can improve it. Stretching and strengthening the surrounding muscles can prevent further problems from developing.

Because doctors know that cancer cells multiply rapidly, most chemotherapy drugs are designed to target tissue that grows rapidly. Therein lies the risk for side effects.

Many types of normal cells also tend to grow and replace themselves quickly. These include the:

• cells that make up the hair, fingernails, and eyelashes
• cells that line the mouth and digestive tract
• red and white blood cells that are made in bone marrow

Oral antihormone drugs, such as aromatase inhibitors, can cause joint pain and reduce bone density. This can put you at risk for developing osteoporosis and fractures.

Other chemotherapy agents, especially taxanes, can damage peripheral nerves in your hands and feet. This can cause:

• numbness
• tingling
• decreased sensation
• pain

Together, these symptoms are known as chemotherapy-induced peripheral neuropathy (CIPN).

CIPN in your hands can make it difficult to perform fine motor tasks, such as writing, holding utensils, and using a keyboard. CIPN in your feet can affect your ability to feel the ground and keep your balance.

In addition, many people experience a decrease in the ability to think. You may forget things, find it difficult to solve simple problems, and feel less coordinated.

These side effects can cause you to compensate by using your limbs and trunk in abnormal ways. You’re not usually conscious of performing these altered movements, but these changes in movement can lead to unexpected problems in your arms, back, hips, and shoulders.

After surgery, it’s not uncommon to experience symptoms such as swelling, pain, and stiffness.

If you do experience these symptoms, it’s best to first seek an evaluation from an orthopedic specialist or a physical therapist. They can teach you how to move and exercise safely.

If you aren’t injured, you can usually proceed with starting an exercise program. 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 you from losing too much mobility and prevent you from developing lymphedema.

Shoulder circles

Shoulder circles can help loosen and warm stiff muscles.

1. Roll the shoulders forward.
2. Continue rolling forward in a circular motion for 10 reps.
3. Reverse the motion and roll your shoulders backward for 10 reps.

Shoulder raises

This exercise can help relieve tension by working additional muscles in the shoulders and armpits.

1. Slowly lift your shoulders in the air, pretending as if you’re raising your shoulders to your ears.
2. Hold the position at the top for 5 seconds.
3. Lower your shoulders to a starting position.
4. Repeat 8 to 10 times, then repeat again 3 to 5 times a day.

Arm raises

This exercise enhances range of motion without requiring you to lift your arms higher than shoulder height.

1. Place your right hand on your right shoulder and your left hand on your left shoulder.
2. Slowly lift your elbows in the air.
3. Stop when your elbows reach shoulder height. (You may not be able to comfortably lift this high just yet. Lift as you’re able.)
4. Slowly lower your elbows to a starting position.
5. Repeat 8 to 10 times.

Arm lifts

This exercise is often recommended as you advance in your recovery and are getting better range of motion in your arms.

1. Stand with your back against a wall, ensuring your posture is straight as you stand.
2. Keeping your arms straight, slowly lift your arms in front of you, stopping when you reach as high as you can. Ideally, this will be with your hands pointing up to the ceiling and arms almost touching your ears.
3. Slowly lower your arms down to return to your starting position. Repeat 8 to 10 times, or as you’re able.

Arm crunches

This exercise helps stretch the armpits and the backs of the shoulders.

1. Lie on the ground with your back on the floor. You may use a pillow for neck support.
2. Put your arms behind your head and hands on your ears. Your elbows will be bent at either side of your head.
3. Slowly lift your elbows toward each other, feeling the stretch as you do.
4. Stop when your elbows are nearly meeting, feeling a stretch in your upper back.
5. Slowly lower your elbows back to a starting position.
6. Repeat 8 to 10 times.

Other treatments

If you develop scarring in your armpit after your lymph nodes are removed, massaging the affected areas can help. Stretching and massage, coupled with anti-inflammatory medications and applications of moist heat, can help relieve this discomfort.

Shop for anti-inflammatory medications and heating pads.

You can’t see radiation-induced fibrosis, but you can feel it when you move your arm and find that your motion is restricted.

Radiation-induced fibrosis can cause pain, tightness, and altered sensation, even months or years after your radiation treatments end. Doctors will often recommend a combination of therapeutic approaches to improve strength and mobility.

Massage therapy

Consider getting regular massages to further help stretch muscles and make them more supple.

You can also focus on self-massage of the affected areas. This can involve you manually rubbing areas that are stiff and tight or purchasing assistive devices that can act as an extension of your hand.

Examples include a foam roller or massage stick, which can help you get to your back or the side of your body.

Shop for a foam roller or massage stick.

Stretching

Perform regular stretching exercises, like the postsurgery exercises listed above.

You may also want to incorporate stretching of your neck, such as making circles with your head. Also try stretching your head forward (by dropping your chin toward your chest) and then looking up toward the ceiling.

Exercise sends a signal to your body to remodel, loosen, and lessen both external and internal scarring. Some scarring will likely remain, but that’s normal.

Strength training

Strengthen your arms, shoulders, and back with weightlifting exercises or by using physical therapy bands. Examples of beneficial exercises include:

• bicep curls
• triceps extensions
• arm raises
• shoulder presses

Shop for physical therapy bands.

Precautions

Always talk to your doctor before starting an exercise or stretching program.

Talk to them before going to get a massage, too. If you’ve had lymph nodes removed, there may be approaches your message therapist should avoid, such as deep pressure or hot and cold therapies.

Chemotherapy can cause many side effects, including neuropathic pain. This nerve pain can be difficult to treat. Many pain medications don’t always work.

The first step is to talk to your doctor about your pain. They may prescribe gabapentin (Neurontin). It’s approved by the U.S. Food and Drug Administration (FDA) to treat nerve pain.

Depending upon the nature of your pain, they may also prescribe pain medications to treat breakthrough pain.

Your doctor may also prescribe a medication “off-label” to treat your symptoms. These prescriptions aren’t expressly approved by the FDA to treat your specific symptoms, but they’re known to help some people.

The off-label medications your doctor prescribes will vary based on your health history and symptoms.

Off-Label Drug Use

Off-label drug use means a drug that’s approved by the FDA for one purpose is used for a different purpose that hasn’t yet been approved. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.

In addition to tightness and stiffness, you may find you have a lot of discomfort caused by friction or sweating at the sites where your surgery or treatments took place. Sometimes, clothes you once wore may feel uncomfortable or restrictive.

To ease these symptoms, you can make the following lifestyle changes:

• Apply cornstarch to your underarm area to reduce friction. Some people recommend putting cornstarch into a sock or stocking, tying a knot at the top, and taping the sock or stocking against the skin.
• Avoid shaving your armpits while you’re receiving radiation treatments.
• Refrain from using hot water when showering to avoid drying out your skin. Use warm water instead.
• Reduce skin irritation by avoiding strong soaps, antiperspirants, or deodorants.
• Wear loose clothing to reduce straining and to allow for stretching and enhanced movement.

The first thing you should do is to recognize your symptoms early and 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 changes in sensation
• 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, too. They may find it appropriate to refer you to an orthopedist, neurologist, or 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 isn’t unusual. Don’t assume 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 serious, such as cancer recurrence or metastasis.

The same advice applies: Report problems early, get properly evaluated, and get some treatment. You can’t fix a problem that you ignore.

Find support from others who are living with breast cancer. Download Healthline’s free app here.