Motor Control Retraining Exercises on Shoulder Dysfunction Post Mastectomy

sixty patients suffering from post-mastectomy shoulder dysfunction will participate in this study. Their ages will range from 40 to 55 years. The participants will be selected from Cairo university hospitals. Design of the study: In this randomised controlled trial study (RCT), the patients will be randomly assigned into two equal groups (30 patients for each group): Group A (study group): This group will include 30 patients with post mastectomy shoulder dysfunction who will receive motor control retraining exercises in addition to their conventional physical therapy program, three sessions per week for 8 weeks, for 45:60 minutes according to patient's ability. Group B (control group): This group will include 30 patients with post mastectomy shoulder dysfunction who will receive conventional physical therapy program in the form of shoulder joint mobilization, posterior capsule stretching and shoulder range of motion exercise (ROM) (Codman's pendulum exercises) for 30 minutes according to patient's ability, three sessions per week for 8 weeks. Measurement equipment: * Hand-held dynamometer: for measurement of muscle strength. * Digital inclinometer: for measurement of shoulder flexion, abduction and scapular upward rotation. * Shoulder Pain and Disability Index (SPADI): for measurement of shoulder disability. Therapeutic procedures: • Motor control retraining exercises of the scapular musculature. Motor control retraining exercises: The motor control retraining package was targeted at correcting movement impairments of the scapula by re-educating muscle recruitment. There were two components to the package: 1. Motor control exercises to correct alignment and coordination, which involve a) learning optimal scapular orientation at rest and then controlling optimal orientation during active arm movements; b) muscle specific exercises for trapezius and serratus anterior 2. Manual therapy techniques commonly used in clinical practice to manage symptoms, as trigger point therapy and pectoralis minor supine manual stretch will be performed as necessary. * Traditional physical therapy.