Scapular Mobilization and Proprioceptive Neuromuscular Facilitation on Shoulder Dysfunction After Latissimus Dorsi Flap Breast Reconstruction

this study will be conducted to investigate the effect of scapular mobilization and scapular Proprioceptive neuromuscular facilitation on shoulder dysfunction after latissimus dorsi flap breast reconstruction

Several procedures are available for patients undergoing breast reconstruction including pedicled faps such as latissimus dorsi fap (LDF) and transverse rectus abdomens myocutaneous flap (TRAM), as well as free flap requiring microvascular anastomoses like the deep inferior perforator flap (DIEP). Some of these, like LDF, may be combined with implants to provide adequate volume and symmetry.Surgeons employ the latissimus dorsi flap (LDF) for reconstruction of a large variety of breast cancer surgery defects, including quadrantectomy, lumpectomy, modified radical mastectomy, and others.The Latissimus dorsi (LD) muscle, in its interaction with other muscles of the shoulder plays an important role in shoulder adduction, extension, and internal rotation, as well as scapular depression and lateral flexion of the torso, Daily activities that rely on the function of the LD include swimming, climbing stairs, rising with the aid of the arms, and walking on crutches, There is therefore concern that the LD muscle flap procedure may impair shoulder function.The abnormal scapular biomechanics that occur as a result of dysfunction create abnormal scapular positions that decrease normal shoulder function. Therefore, treatment of shoulder dysfunction should include scapular-mobility exercises, or scapular-mobilization (SM) techniques. scapular mobilization and the combined application of techniques resulted in higher achievements, which may be related to increased scapular mobility and thus, the increased range of motion of the glenohumeral joint after scapular mobilization. Proprioceptive neuromuscular facilitation is an approach to therapeutic exercise that combines functionally based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function. Limited research is available on the impact combined effect of scapular mobilization and scapular proprioceptive neuromuscular facilitation on shoulder dysfunction after latissimus dorsi flap breast reconstruction Therefore, this study aims to examine the combined therapeutic effect of both techniques on shoulder dysfunction to aid in planning an ideal physical therapy rehabilitation program for shoulder dysfunction after latissimus dorsi flap breast reconstruction.

Inclusion Criteria: * age ranged from 40 to 55 years. * All patients were female patients suffering from shoulder dysfunction after latissimus dorsi flap breast reconstruction. * All patients suffering from moderate or severe pain on shoulder joint and limited range of motion that may affect daily activities. * All patients begun the treatment program 3 to 4 weeks after LDF breast reconstruction. * Informed consent was obtained from every patient enrolled in the trial. Exclusion Criteria: * Current metastases. * Neurological deficit affecting the shoulder functioning during daily activities. * Pathology of the shoulder joint including rotator cuff tear adhesive capsulitis and tendinitis. * Pain or disorder of the cervical spine, elbow, wrist or hand. * Shoulder surgery, shoulder dislocation fracture acromioclavicular joint osteoarthritis. * Diabetes. * Pregnancy. * Shoulder manipulation under anesthesia, local corticosteroid injection. * Psychological disorders.