Shoulder and Upper-Quarter Problems After Breast Cancer Treatment: What Two Randomized Trials Found, Early and Late

Physical therapists, physical therapist assistants working under the direction and supervision of a physical therapist, and certified hand therapists who see women during or after breast cancer treatment and who encounter cording, shoulder stiffness, and persistent shoulder pain in the upper quarter.

Licensed physical therapists, physical therapist assistants and certified hand therapists in outpatient, hospital-based, oncology and hand therapy settings. Physical therapist assistants may take this course; the content describes their contribution as carrying out the plan of care established by the supervising physical therapist.

Intended audience

Physical Therapy

Level

Intermediate

Delivery format

Online, asynchronous, self-paced course: interactive reading with audio or video, and a scored post-test.

Based on

González-Rubino JB, Martín-Valero R, Vinolo-Gil MJ. Physiotherapy protocol to reduce the evolution time of axillary web syndrome in women post-breast cancer surgery: a randomized clinical trial. Support Care Cancer. 2025;33(4):326. doi:10.1007/s00520-025-09373-1

Feder KM, Lautrup MD, Nielsen SM, Egebæk HK, Rahr HB, Christensen R, Ingwersen KG. Effectiveness of an individualised treatment plan compared with a standard exercise programme in women with late-term shoulder impairments after primary breast cancer treatment: a randomised controlled trial. Acta Oncol. 2025;64:448–457. doi:10.2340/1651-226X.2025.42737

After completing this course, you will be able to:

1. Describe what the axillary web syndrome trial reported about pain, shoulder motion and time to resolution when stretching with manual cord and scar release was added to a home exercise and education program early after breast cancer surgery.
2. State what the late-term shoulder trial found when a shoulder expert assessment followed by an individualized treatment plan was compared with a standardized exercise program delivered as a pamphlet in women three to seven years after primary breast cancer treatment.
3. Distinguish early post-surgical cording from late-term shoulder impairment in terms of who was studied, what treatment was tested, how certain each trial's findings were, and what each study's authors concluded.

1. Start Here: How This Course Works
2. Part One: A Hands-On Protocol for Axillary Web Syndrome After Breast Cancer Surgery
3. Who Took Part: Women With Painful Cording After Breast Cancer Surgery
4. How the Cording Trial Was Run: Home Exercise Alone or Home Exercise Plus Hands-On Sessions
5. What the Cording Trial Found: Pain, Motion and Time to Resolution
6. Reading the Cording Trial With Care: Limits, Safety and What the Authors Concluded
7. Part Two: An Individualized Plan Versus a Standard Exercise Program for Late-Term Shoulder Impairment
8. Who Took Part: Women With Shoulder Symptoms Three to Seven Years After Treatment
9. How the Late-Term Trial Was Run: Expert Assessment Versus an Exercise Pamphlet
10. What the Late-Term Trial Found: Shoulder Pain and Disability at Twelve Weeks
11. Why the Late-Term Trial Cannot Settle the Question: Recruitment, Power and Access
12. Bringing It Together
13. Where the Two Trials Agree
14. Where the Two Trials Point in Different Directions
15. What the Two Trials Support in a Plan of Care, and the Physical Therapist Assistant's Part
16. What the Two Trials Leave Unanswered
17. Key Takeaways
18. Post-Test and Course Evaluation

Quinn Millington, PT, DPT, ECS is the instructor of record: the licensed clinician who reviewed this course and signed off on it. The name and credentials print on the certificate.

Disclosures. This course was developed by The ConEd Solution, which has a financial interest in its sale. No outside funding or sponsorship was received. The instructor of record has no affiliation with the authors of the source publication or their institutions.

This course awards 1.0 contact hour (60 min). How you earn them:

1. Complete the course. Every lesson, in order.
2. Pass the post-test. Score 80% or higher. Retakes are allowed.
3. Complete the evaluation. A short form rating each learning objective and the course.
4. Download your certificate. It is issued on completion and stays available in My Account.

The episode time is its measured length. Reading, post-test and evaluation times are estimates.

This course is designed to satisfy the quality requirements state boards set for continuing education. Requirements vary by state, and confirming that a course fits your renewal is up to you. Each state’s own acceptance statement is in the credit panel on this page.

1. González-Rubino JB, Martín-Valero R, Vinolo-Gil MJ. Physiotherapy protocol to reduce the evolution time of axillary web syndrome in women post-breast cancer surgery: a randomized clinical trial. Support Care Cancer. 2025;33(4):326. doi:10.1007/s00520-025-09373-1
2. Feder KM, Lautrup MD, Nielsen SM, Egebæk HK, Rahr HB, Christensen R, Ingwersen KG. Effectiveness of an individualised treatment plan compared with a standard exercise programme in women with late-term shoulder impairments after primary breast cancer treatment: a randomised controlled trial. Acta Oncol. 2025;64:448-457. doi:10.2340/1651-226X.2025.42737