Impact of Proximal Motor Control Exercise on Scapular Muscles Activation Pattern in Breast Cancer Survivors Following Mastectomy

NCT07103109 | Completed

• 1 other identifier: Scapular Ms -Mastectomy 2025
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

This prospective, single-center, assessor-blinded, parallel-group randomized controlled trial investigated whether adding proximal motor control exercises (PMCE) to conventional physiotherapy treatment (CPT) improved shoulder function and scapular muscle activation in women with post-mastectomy shoulder dysfunction. Women aged 35-55 years were randomly allocated to receive either PMCE plus CPT or CPT alone. Both groups attended supervised physiotherapy sessions three times weekly for 6 weeks. Outcomes were assessed at baseline, immediately after treatment, and at 12-week follow-up. The primary outcome was scapular and shoulder muscle activation assessed using surface electromyography (SEMG), while secondary outcomes included shoulder pain and disability assessed using the Shoulder Pain and Disability Index (SPADI).

Conditions

Post Mastectomy

Keywords

Proximal stabilization

Outcome Measures

Primary Outcomes (1)

• EMG Muscle Activation

  Surface electromyography (sEMG) was used to assess the activation patterns of the serratus anterior, upper and lower trapezius, supraspinatus, and infraspinatus muscles during arm elevation. The sEMG assessment was conducted using a wireless sEMG system with a sampling rate of 2000 Hz and a bandwidth of 20-500 Hz. Pre-gelled, disposable, self-adhesive Ag/AgCl electrodes were placed over the muscle bellies according to the SENIAM recommendations, with an inter-electrode distance of 20 mm.

  Baseline, 6 weeks and 12 weeks follow up

Secondary Outcomes (1)

• Shoulder pain and disability index (SPADI)

  Baseline, 6 weeks and 12 weeks follow up

Study Arms (2)

study group

EXPERIMENTAL

Other: Proximal Motor Control exercises; Other: Conventional physical therapy

control

ACTIVE COMPARATOR

Other: Conventional physical therapy

Interventions

Conventional physical therapy OTHER

CPT consisted of glenohumeral joint mobilization, posterior capsule stretching, and Codman pendulum exercises. Joint mobilization included distraction, caudal, and posterior glides using Grade 1-2 oscillations for approximately 2 minutes. Posterior capsule stretching was performed with the shoulder at 90° flexion, holding each stretch for 20 seconds for 10 repetitions with 30 seconds of rest. Codman pendulum exercises were performed in anterior-posterior, medial-lateral, and circular directions without resistance to facilitate gentle shoulder mobility. The CPT program was administered three times per week for six consecutive weeks.

control; study group

Proximal Motor Control exercises OTHER

The PMCE program was: Participants were trained to achieve and maintain optimal scapular positioning using visual, verbal, tactile, and kinesthetic feedback, followed by controlled arm elevation to 90° in the sagittal, frontal, and scapular planes. Muscle-specific exercises included prone 135° elevation for the lower trapezius, wall slides with scapular protraction for the serratus anterior, full-can scaption for the supraspinatus, and resisted external rotation for the infraspinatus. Upper trapezius activation was incorporated during controlled arm elevation. Exercises were performed for three sets of 10 repetitions with 6-second holds and 60-90 seconds of rest. Resistance started at approximately 0.5-1.0 kg and was progressively increased according to the participant's ability to maintain proper scapular alignment without compensatory movement or increased symptoms. The PMCE program was administered three times per week for six consecutive weeks.

study group

Eligibility Criteria

• Age: 35 Years - 55 Years
• Gender Eligibility Details: Post-mastectomy female subjects
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Had stage I-III unilateral breast cancer. Had undergone simple or modified radical mastectomy at least 3 months before enrollment.
• Had achieved complete postoperative wound healing and were medically stable. Had clearance from their treating physician to participate in exercise. Presented with post-mastectomy shoulder dysfunction, defined as a SPADI score ≥30/100 and a positive Scapular Dyskinesis Test.

You may not qualify if:

• Had undergone bilateral mastectomy. Had evidence of locoregional recurrence or metastatic breast cancer. Had a history of previous shoulder surgery or major shoulder trauma unrelated to breast cancer treatment.
• Had pre-existing shoulder disorders, including rotator cuff tears, adhesive capsulitis, or advanced glenohumeral osteoarthritis.
• Had neurological disorders affecting upper-limb function. Had rheumatologic diseases affecting shoulder function. Had uncontrolled diabetes mellitus or any other medical condition contraindicating exercise participation.

Sponsors & Collaborators

• Ahram Canadian University: lead
• Benha University: collaborator

Study Sites (1)

Out patient clinic , faculty of Physical Therapy, Ahram Canadian university

Giza, Giza Governorate, Egypt

Location

Study Officials

• Mohamed Naeem, Ph.D

  Faculty of Physical Therapy, Beni Sueif university

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The SPADI assessor, SEMG examiner, and statistician remained blinded to group allocation throughout data collection and analysis.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Model Details: This is a parallel group randomized controlled trial

Study Record Dates

• First Submitted: July 29, 2025
• First Posted: August 5, 2025
• Study Start: August 5, 2025
• Primary Completion: September 7, 2026
• Study Completion: September 7, 2026
• Last Updated: September 11, 2026

Record last verified: 2025-08

Locations

EG (1)