Discussion
ligamentous rigidity, shoulder abduction, Pain, muscle impairment, pain, shoulder flexion, muscle stiffness, depression, shoulder dysfunction, abduction
JOINT DISORDER, FROZEN SHOULDER, DYSFUNCTION, ADVERSE EFFECTS, ADHESIONS
Pain and ROM restriction within AC are likely due to fascial constraints, muscle stiffness with trigger spots, in addition to capsular and ligamentous rigidity [Following mastectomy, the main cause of shoulder dysfunction is not only the glenohumeral joint disorder but also the adhesions in the axillary and pectoral areas between the pectoral muscles, subcutaneous tissue, and skin that may prevent complete extension of the pectoralis, resulting in limitation of both shoulder flexion and abduction [Shrug sign is one of the issues that may be exhibited during application of resistance exercises for shoulder abduction. One of the benefits of Thera-Band is the ability to assist in rotator cuff retraining during starting abduction, as the elastic band generates “upward and inward” resistance vector against which the patient must push in a “downward and outward” direction. This action activates the start of abduction additionally the rotator cuff’s depression and stability activities, which occur before and during abduction. According to anecdotal evidence, this exercise helps patients with the shrug sign diminish early upper trapezius activity during abduction [In terms of muscle strength, the resistance training group demonstrated better statistical results, which could be illustrated by the fact that strengthening exercises cause significant physiological variations in skeletal muscles including contractile and/or non-contractile muscle compositions. Mechanical stress causes disruption of myofibers and extracellular matrix, which stimulates protein synthesis, resulting in muscle growth by increment the sarcomeres number, which leads to an increase in pinnation angle and fascicle length and so muscle expansion [Several studies have documented alteration of scapular motion in the mastectomy side which in turn affect the shoulder motion pattern and contribute to incidence of frozen shoulder [Moreover, the experimental group demonstrated greater improvement in ADL regarding to the DASH scores and additionally in QoL which may be attributed to the crucial role of strengthening exercises among the various forms of physical exercise programs due to the link between muscle impairment, pain, and dysfunction [The study confirmed the importance of exercises therapy in AC management without reporting any adverse effects and presents the preliminary evidences for introducing strengthening exercises as an essential part in AC rehabilitation; however, some limitations must be considered when explaining these results; the most significant drawback of this experiment was the lack of scapular movement analysis which could provide better statistical results; other restrictions are the absence of blinding during the treatment sessions and absence of AC imaging assessments that could provide better prognosis; also the long-term effect of treatment was not examined due to the difficulty of following up after the trial, so future trials analyzing the scapular motion with patients’ follow-up are recommended; also it is critical to promote knowledge about the protection, early diagnosis, and quick treatment of shoulder problems following mastectomy in order to reduce women sufferance and financial costs, so trials should be conducted to evaluate early physical therapy intervention in prevention shoulder morbidity following mastectomy; moreover, evaluation of the impact of different approaches of exercises therapy with longer duration should be carried out.