Scapular Mobilization and Proprioceptive Neuromuscular Facilitation on 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.