Title Page
Abstract
Contents
1. Introduction 12
1.1. Background and necessity 12
1.2. Purpose 15
1.3. Hypotheses 15
2. Theoretical background 16
2.1. Anatomical structure of the shoulder joint 16
2.2. Breast cancer and mastectomy 17
2.3. Joint mobilization 19
2.4. Manual lymph drainage 21
3. Methods 22
3.1. Subjects 22
3.2. Study procedures 23
3.3. Study methods(interventions) 25
3.3.1. Kaltenborn-Evjenth concept functional glide(KEFG) 26
3.3.2. Mulligan technique movement with mobilization(MWM) 28
3.3.3. Manual lymph drainage 30
3.3.4. Conventional physical therapy 31
3.4. Assessment 32
3.4.1. Pain 32
3.4.2. Range of motion 33
3.4.3. Upper extremity dysfunction 35
3.4.4. Arm volume 36
3.4.5. Handgrip strength 37
3.4.6. Quality of life 38
3.5. Statistical analysis 39
4. Results 40
4.1. General characteristics of subjects and homogeneity tests 40
4.2. Comparison of the pain scores 41
4.3. Comparison of the range of motion 43
4.3.1. Comparison of shoulder flexion 43
4.3.2. Comparison of shoulder abduction 45
4.3.3. Comparison of shoulder external rotation 47
4.3.4. Comparison of shoulder internal rotation 49
4.4. Comparison of upper extremity dysfunction 51
4.4.1. Comparison of the SPADI pain 51
4.4.2. Comparison of the SPADI disability 53
4.4.3. Comparison of the SPADI total 55
4.5. Comparison of the arm volume 57
4.5.1. Comparison of the hand volume 57
4.5.2. Comparison of the wrist volume 59
4.5.3. Comparison of the forearm volume 61
4.5.4. Comparison of the elbow volume 63
4.5.5. Comparison of the upper arm volume 65
4.6. Comparison of the handgrip strength 67
4.7. Comparison of the quality of life 68
4.7.1. Comparison of the SF-36 physical functioning 68
4.7.2. Comparison of the SF-36 role physical 70
4.7.3. Comparison of the SF-36 bodily pain 71
4.7.4. Comparison of the SF-36 general health 73
4.7.5. Comparison of the SF-36 vitality 75
4.7.6. Comparison of the SF-36 social functioning 76
4.7.7. Comparison of the SF-36 role emotional 77
4.7.8. Comparison of the SF-36 mental health 78
5. Discussion 80
5.1. Shoulder joint mobilization and pain 81
5.2. Shoulder joint mobilization and range of motion 82
5.3. Shoulder joint mobilization and upper extremity dysfunction 84
5.4. Shoulder joint mobilization and arm volume 85
5.5. Shoulder joint mobilization and handgrip strength 87
5.6. Shoulder joint mobilization and quality of life 88
5.7. Limitations 90
6. Conclusion 91
II. List of references 93
III. List of abbreviations 106
VI. Appendix 109
6.1. Shoulder Pain and Disability Index(Korean ver.) 109
6.2. SF-36(Korean ver.) 110
6.3. Abstract(Korean) 114
6.4. Agreement to Participate in Research(Korean ver.) 116
6.5. Agreement to participate in research(English ver.) 117
6.6. Explanation for the subject agreement(Korean Ver.) 118
6.7. Explanation of the participants' agreement(English ver.) 120
Table 1. Interventions 25
Table 2. General characteristics of subjects and homogeneity tests 40
Table 3. Comparison of the pain scores(VAS) between the KEFG and MWM groups 41
Table 4. Comparison of shoulder flexion ROM between the KEFG and MWM groups 43
Table 5. Comparison of shoulder abduction ROM between the KEFG and MWM groups 45
Table 6. Comparison of shoulder external rotation ROM between the KEFG and MWM groups 47
Table 7. Comparison of shoulder internal rotation ROM between the KEFG and MWM groups 49
Table 8. Comparison of the SPADI pain between the KEFG and MWM groups 51
Table 9. Comparison of the SPADI disability between the KEFG and MWM groups 53
Table 10. Comparison of the SPADI total between the KEFG and MWM groups 55
Table 11. Comparison of the hand volume between the KEFG and MWM groups 57
Table 12. Comparison of the wrist volume between the KEFG and MWM groups 59
Table 13. Comparison of the forearm volume between the KEFG and MWM groups 61
Table 14. Comparison of the elbow volume between the KEFG and MWM groups 63
Table 15. Comparison of the upper arm volume between the KEFG and MWM groups 65
Table 16. Comparison of the handgrip strength between the KEFG and MWM groups 67
Table 17. Comparison of the SF-36 PF between the KEFG and MWM groups 68
Table 18. Comparison of the SF-36 RP between the KEFG and MWM groups 70
Table 19. Comparison of the SF-36 BP between the KEFG and MWM groups 71
Table 20. Comparison of the SF-36 GH between the KEFG and MWM groups 73
Table 21. Comparison of the SF-36 VT between the KEFG and MWM groups 75
Table 22. Comparison of the SF-36 SF between the KEFG and MWM groups 76
Table 23. Comparison of the SF-36 RE between the KEFG and MWM groups 77
Table 24. Comparison of the SF-36 MH between the KEFG and MWM groups 78
Figure 1. Flow chart 24
Figure 2. Kaltenborn-Evjenth concept functional glide(dorsal) 26
Figure 3. Kaltenborn-Evjenth concept functional glide(caudal) 27
Figure 4. Mulligan technique MWM(dorsal) 28
Figure 5. Mulligan technique MWM(caudal) 29
Figure 6. Manual lymph drainage 30
Figure 7. Visual analog scale 32
Figure 8. Goniometer 34
Figure 9. Range of motion 34
Figure 10. Measuring tape 36
Figure 11. Points of arm measurement 36
Figure 12. EH-101 37
Figure 13. Handgrip strength measurement 37
Figure 14. Comparison of the pain scores between the KEFG and MWM groups 42
Figure 15. Comparison of shoulder flexion ROM between the KEFG and MWM groups 44
Figure 16. Comparison of shoulder abduction ROM between the KEFG and MWM groups 46
Figure 17. Comparison of shoulder external rotation ROM between the KEFG and MWM groups 48
Figure 18. Comparison of shoulder internal rotation ROM between the KEFG and MWM groups 50
Figure 19. Comparison of the SPADI pain between the KEFG and MWM groups 52
Figure 20. Comparison of the SPADI disability between the KEFG and MWM groups 54
Figure 21. Comparison of the SPADI total between the KEFG and MWM groups 56
Figure 22. Comparison of the hand volume between the KEFG and MWM groups 58
Figure 23. Comparison of the wrist volume between the KEFG and MWM groups 60
Figure 24. Comparison of the forearm volume between the KEFG and MWM groups 62
Figure 25. Comparison of the elbow volume between the KEFG and MWM groups 64
Figure 26. Comparison of the upper arm volume between the KEFG and MWM groups 66
Figure 27. Comparison of the SF-36 PF between the KEFG and MWM groups 69
Figure 28. Comparison of the SF-36 BP between the KEFG and MWM groups 72
Figure 29. Comparison of the SF-36 GH between the KEFG and MWM groups 74
Figure 30. Comparison of the SF-36 MH between the KEFG and MWM groups 79