Original Research

Measurement of Pectoralis Minor S.E. Harrington, PT, PhD, Department

of Exercise Science, Physical Therapy
Program, University of South Carolina,
Muscle Length in Women Diagnosed Blatt PE Center, 101G, Columbia, SC

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29208 (USA). Address all

With Breast Cancer: Reliability, correspondence to Dr Harrington at:

sharring@mailbox.sc.edu.
J. Hoffman, PT, DPT, Department of
Validity, and Clinical Application Physical Therapy, Creighton University,
Omaha, Nebraska.
Shana E. Harrington, Julie Hoffman, Dimitrios Katsavelis D. Katsavelis, PhD, Department of
Exercise Science, Creighton University.
[Harrington SE, Hoffman J, Katsavelis
Background. Decreased pectoralis minor muscle length is common after primary breast D. Measurement of pectoralis minor
cancer treatment and can result in an abnormal position of the scapula. This position muscle length in women diagnosed
can contribute to shoulder pain and pathomechanics and can lead to problems such as with breast cancer: reliability, validity,
impingement syndrome, rotator cuff tears, and frozen shoulder. Currently, there are limited and clinical application. Phys Ther.
reliable methods for measuring pectoralis minor length. 2020;100:1–9.]
© 2020 American Physical Therapy
Objective. The objective of this study was to examine the reliability and validity of Association
measuring pectoralis minor length in women diagnosed with breast cancer.
Accepted: September 23, 2019
Submitted: January 3, 2019
Design. This was a cross-sectional reliability and validity study.
Methods. Bilateral pectoralis minor length (in centimeters) was assessed using a
palpation meter in women (N = 29) diagnosed with breast cancer by 2 licensed physical
therapists who were masked to the measures. Bilateral pectoralis minor length was also
measured using a motion capture system to assess validity.

Results. Intratester reliability (intraclass correlation coefficient, ICC [3,k] = 0.971; 95%
confidence interval [CI] = 0.939–0.986; standard error of measurement [SEM] = 0.16 cm)
and intertester reliability (ICC[3,k] = 0.915; 95% CI = 0.81–0.962; SEM = 0.31 cm) were
excellent for the palpation meter on the affected side and the unaffected side (intratester
reliability: ICC[3,k] = 0.951; 95% CI = 0.897–0.977; SEM = 0.19 cm; intertester reliability:
ICC[3,k] = 0.945; 95% CI = 0.877–0.975; SEM = 0.22 cm). Significant correlations were
found between the motion capture system and the palpation meter on the affected side
(r = 0.87) and the unaffected side (r = 0.81). Bland-Altman plots between the palpation
meter and the motion capture system demonstrated that all the measures fell within the
limits of agreement.

Limitations. This study encountered possible errors with the accuracy of the motion
capture system tracking because of the proximity of the markers and inherent volumetric
restrictions.

Conclusions. The palpation meter is a reliable, valid, easily administered, and cost-
effective tool for assessing pectoralis minor length in women with breast cancer.

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2020 Volume 100 Number 3 Physical Therapy 1

Pectoralis Minor Length in Breast Cancer
I
n 2019, it was estimated that over 268,000 women in
the United States would be diagnosed with
breast cancer.1 Currently, 3.1 million women have been
diagnosed with and treated for breast cancer in the United
States.1 Because of advancements in detection and
treatment, approximately 89% of these women will survive
for 5 years or longer.2 Traditionally, management of breast
cancer often primarily focuses on tumor response to
treatment and survival rate.3 However, with improved
survivorship, the focus on function and quality of life
related to breast cancer treatment has now gained
significantly more attention.4
The majority of women diagnosed with breast cancer will
undergo some form of lymph node dissection (sentinel
lymph node dissection or axillary lymph node dissection)
and most will receive either breast-conserving or
mastectomy surgery.5 It is well documented that upper
extremity impairments may develop within weeks or
months after these surgeries for breast cancer and can be
difficult to treat.6,7 These impairments include decreased
shoulder active and passive range of motion, decreased
upper extremity strength, and pain; these have been
shown to negatively affect upper extremity function and
quality of life.6,8–10 Because of its proximity to the surgical
and radiation fields, the pectoralis minor muscle has been
linked to many of these impairments.11 The pectoralis
minor muscle originates at the medial coracoid process of
the scapula and inserts on ribs 2 through 5. It is situated
in a key location to be adversely affected by a variety of
breast cancer treatments, including surgery12 and radiation
therapy.13,14 A variety of factors could influence pectoralis
minor muscle length, although literature to explain this is
sparse in women diagnosed with breast cancer. The
pectoralis minor muscle may be compromised when it is
used to fill a lumpectomy cavity as described by Manaswi
and Mehrotra.15 Additionally, in women who received
radiotherapy for breast cancer, a significantly smaller
(bilateral cross-sectional area using magnetic resonance
imaging [MRI]) pectoralis minor muscle on the affected
side was found compared with the unaffected side.11
Decreased pectoralis minor length is common after
primary breast cancer treatment and can result in an
abnormal position of the scapula (protracted and
depressed).12 Alterations in scapular position are not only
undesirable but are also believed to contribute to shoulder
pain and pathomechanics, leading to problems such as
impingement syndrome, rotator cuff tears, frozen
shoulder, and glenohumeral instability.16–23 The cause of
pectoral minor tightness in women diagnosed with breast
cancer is multifactorial.12 Pain resulting from breast cancer
surgery may cause the pectoralis minor muscle to exhibit
increased tone,12 whereas radiation may cause fibrosis of
the pectoralis minor muscle sheaths and tendons,
producing further tightness.24 Additionally, women may
try to protect their surgical sites through increased flexion
of the thoracic spine and protraction of the scapula, which
may intensify pectoralis minor shortening.12
2 Physical Therapy Volume 100 Number 3
The importance of pectoralis minor length and its
contribution to upper extremity function are well
documented in the scientific literature. However, there are
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only a few reported methods in the literature describing
how to clinically assess pectoralis minor length. These
methods have several limitations, including limited
psychometric properties (eg, reliability, validity, and
responsiveness), and may not be feasible on women who
have been treated for breast cancer.25 A common clinical
method to examine pectoralis minor muscle length is to
use a flexible tape measure from the coracoid process to
the fourth intercostal space.26 However, this method could
prove difficult to apply to women who have undergone
surgery for breast cancer because of breast tissue
deformities and irregularities that often result from
common surgical techniques used to remove the cancer.
The most common clinical method to assess pectoralis
minor length is to measure the distance from the
posterolateral angle of the scapula to the examination
table of a patient in supine.25 However, measurements
obtained using this method have been shown to be poorly
correlated with a normalized measure of pectoralis minor
length27 and have been found to have poor diagnostic
accuracy.28 Measuring resting scapula position, as
described with the Lennie Test, is an additional technique
often used to indirectly measure the length of the
pectoralis minor; however, poor to moderate reliability
and validity have been reported with this method.29–31
Using MRI scans to examine cross-sectional size of the
pectoralis minor has also been reported in the literature
although this is another form of an indirect technique that
has a variety of limitations. A cross-sectional study
conducted by Shamley et al revealed that the pectoralis
minor was significantly smaller on the affected side
compared with the unaffected side in 74 women treated
for unilateral breast cancer.11 Unfortunately, the
methodology used to discover this decrease in pectoralis
minor length included the use of MRI scans, which are
extremely costly and time-consuming, are not feasible in
daily clinical practice, and cross-sectional size does not
directly examine muscle length.11 Because of these
limitations, what is needed is a simple and cost-effective
tool that can be used in clinical and research settings that
can objectively measure pectoralis minor length in women
treated for breast cancer.
The PALpation Meter (PALM; Performance Attainment
Associates, St Paul, MN) (Fig. 1) combines a caliper and an
inclinometer into 1 tool that measures distance. In a
recent study by Rondeau et al, the PALM was used to
measure pectoralis minor length in 29 overhead athletes.
Intrarater reliability was found to be reliable and precise
for both the dominant (intraclass correlation coefficient
(ICC)[2,k] = 0.980; standard error of measurement
[SEM] = 0.32 cm) and nondominant (ICC[2,k] = 0.990;
SEM = 0.29 cm) arms.32 Additionally, the PALM has been
shown to be a valid and reliable instrument for assessing
scapular orientation and postural alignment, including
2020

Figure 1.
PALpation Meter (PALM; Performance Attainment Associates, St
Paul, MN) placed on the participant to measure pectoralis minor
length.
pelvic height and leg length discrepancies.33–35 Therefore,
it is well suited for use as an objective measurement of
pectoralis minor length in women receiving treatment for
breast cancer because it is both cost effective (costing
approximately $225) and user-friendly.36 We are unaware
of any literature establishing the reliability and validity of
the PALM for measuring pectoralis minor length in women
diagnosed with breast cancer. Determining the reliability
and validity of the PALM would enable clinicians and
researchers the capacity to objectively assess pectoralis
minor length in these women, which could help guide the
rehabilitation process. Therefore, the purpose of this study
is to examine the reliability and validity of the PALM when
measuring pectoralis minor length in women diagnosed
with breast cancer.
Methods
Participants
This cross-sectional study enrolled 29 women who had a
breast cancer diagnosis from 2015 to 2016. This sample
size was based on previous literature to assess the
reliability and validity of the PALM.32–35 Eligible
participants included adult women who had been treated
for breast cancer in the Omaha, Nebraska, and Council
Bluffs, Iowa, regions of the United States. The eligibility
criteria included women who had a diagnosis of stage 0 to
III breast cancer within the past 3 years, who were 19 to
85 years old, who had received treatment for unilateral
breast cancer, who had completed primary breast cancer
treatment (surgery, chemotherapy, and/or radiation), and
who had no current recurrence of cancer. Prior to
participation, all participants signed an informed consent
form approved by the Creighton University Institutional
Review Board.
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Pectoralis Minor Length in Breast Cancer
Procedures
Prior to the start of the study, 2 licensed physical
therapists with a combined 34 years of clinical experience
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underwent a training session lasting approximately 1 hour
to familiarize themselves with the testing procedures. This
session instructed the examiners in performing an
accurate measurement of the pectoralis minor length
using the PALM, including bony landmark palpation and
pilot testing on 6 people who were healthy. Participants
reported to the Rehabilitation Science Research
Laboratory at Creighton University and data collection
lasted approximately 45 minutes. Participants wore either
a tank top or sports bra so their shoulders could be
appropriately exposed for preparation of measurements to
be taken. After signing the institutionally approved
informed consent form, 3 trials of bilateral pectoralis
minor length were assessed using the PALM by a licensed
physical therapist with 16 years of clinical experience.
Pectoralis minor length was obtained by placing the
caliper tips of the PALM on the medial coracoid process
and the fourth intercostal space (central location) adjacent
to the sternum on the participants’ affected and unaffected
arms (Fig. 1).25,27,32 The “central vector” as described
elsewhere25 was measured in centimeters and was defined
as the pectoralis minor length for this study. First, the
researcher demonstrated a standing resting position to the
participants. Participants were then asked to stand still in
their preferred resting position, with arms relaxed, while 3
consecutive measurements, lasting approximately 5
seconds each, were performed with the PALM for each
shoulder. Participants were given a 30-second break
between each measurement during which they were
asked to rest, and the PALM was reset to 0. The physical
therapist using the PALM was masked regarding the actual
pectoralis minor length measures while another trained
clinician stood adjacent to the tester, lifting the paper that
covered the measure and recording each pectoralis minor
length. This process was then replicated by a second
licensed physical therapist who had 18 years of clinical
experience. Because we are unaware of a gold standard
reference test for the measurement of pectoralis minor
length28 we chose to use a 6-camera optoelectronic
motion capture system (Oqus 5+; Qualisys AB,
Gothenburg, Sweden) (hereafter referred to as Qualisys)
as our reference standard.
After the PALM measures were completed, therapist 1
placed 2 lightweight reflective markers (12 mm) at the
origin and insertion of each pectoralis minor muscle,
which corresponds to the same areas as where the PALM
calipers were placed as described above.
Three-dimensional coordinates were acquired at 120 Hz
using the Qualisys (Fig. 2). This specific system has
precision in detecting the marker with a mean error of
<0.15 mm. Participants were once again instructed to
stand still in their preferred resting position, with arms
relaxed within the field of view of the motion capture
system. Three 5-second trials were recorded and stored on
Volume 100 Number 3 Physical Therapy 3
Pectoralis Minor Length in Breast Cancer
Figure 2.
Qualisys Tracking Manager (Qualisys AB, Gothenburg, Sweden)
marker placement.
a PC for further analysis. The Qualisys Tracking Manager
(Qualisys AB, Gothenburg, Sweden) software calculated
the average distance during the entire 5-second interval.
Five-second intervals are commonly used with motion
capture to avoid inconsistency that could be caused by
slight motion.37 Additionally, during the training sessions
of the examiners, approximately 5 seconds were required
for the third examiner to review (because the output was
hidden) and record the measurement from the PALM.
Participant demographics—age, side involved, stage of
cancer, type of surgery, date of surgery, whether a lymph
node dissection was performed, type of lymph node
dissection, number of positive lymph nodes, adjuvant
treatment (chemotherapy, radiation therapy, hormone
therapy), hand dominance, height, and weight—were
collected after the pectoralis minor measures were
completed to minimize bias of the examiners knowing the
participants’ breast cancer history and treatment.
Data Reduction
The “central vector” of the pectoralis minor, which is
defined as the 3-dimensional distance from the origin to
the insertion points of the muscle, was recorded with the
Qualisys Tracking Manager software. The same software
was used to process and calculate the distance for each
5-second interval. The 3 trials were averaged for each
participant and each side separately so they could be used
in the ICC analysis for the affected and nonaffected sides.
Data Analysis
Intratester and intertester reliability and precision of the
PALM measuring pectoralis minor length were determined
by calculating the ICC(3,k) and SEM values. Bivariate
Pearson product moment correlation analysis was used to
examine the relationship between the PALM (clinical
assessment) and the motion capture system (laboratory
and reference standard) for both the affected and
unaffected arms. The correlation coefficients were used to
4 Physical Therapy Volume 100 Number 3
determine the criterion validity of the PALM pectoralis
minor length with an a priori alpha level of .05.
Bland-Altman analysis with graphic plots followed by
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linear regression was used to study agreement and
proportional bias between the PALM and Qualisys
measures.38 ,39 Several steps occurred to conduct the
analysis using Bland-Altman. First, the difference between
each value measured by the PALM and Qualisys for each
participant was calculated with a 1-sample t test. Next, an
average of the values measured by the PALM and Qualisys
was calculated for every participant on the affected and
unaffected arm. Both the difference and the average for all
participants were then placed in a scatterplot, with the
average values obtained by the PALM and Qualisys on the
y-axis and the between-method difference on the x-axis.
The mean difference between the PALM and the Qualisys
and the 95% CIs were marked. The mean difference ±1.96
times the SD of the mean difference was added to the plot
to derive the limits of agreement. These limits defined the
interval in which differences between the PALM and the
Qualisys could be expected for 95% of future
measurements in comparable people.38 The figure plots
the amount of agreement or disagreement between the
PALM and the Qualisys and illustrates how the agreement
or disagreement is related to the magnitude of the
measured values.40 A mean difference close to y = 0 is a
good indicator of agreement. A linear regression was
calculated using the difference calculated between the
PALM and Qualisys to examine whether there is
proportional bias. If P >.05, there is no proportional bias
in the measures.41 The minimal detectable change (MDC)
based on a 95% CI (MDC95 ) was calculated using the
√
following equation: MDC95 = SEM × 1.96 × 2.42 The
√
SEM was calculated as follows: SEM = s 1 − ICC, where s
is the pooled SD of the measurements. Statistical analyses
were performed with IBM SPSS Statistics Version 25.0
(IBM SPSS, Chicago, IL, USA).
Role of the Funding Source
This work was supported by the Dr George F. Haddix
President’s Faculty Research Fund of Creighton University
(to S.E.H.). The funder played no role in the design,
conduct, or reporting of this study.
Results
A total of 29 women who were 61.6 (±10.6) years old and
had a diagnosis of unilateral breast cancer (14.8 [±6.63]
months since surgery) participated in the intrarater
reliability and validity portions of this study. Because of
schedule conflicts for therapist 2, 26 of the 29 women
participated in the interrater reliability assessment; those
26 women were 61.5 (±10.6) years old and had a
diagnosis of breast cancer (14.8 [±6.50] months since
surgery). Participant demographics are shown in Table 1.
Intratester reliability was excellent43 for the affected arm
(ICC[3,k] = 0.971; 95% CI = 0.939–0.986; SEM = 0.16 cm)
2020
 Pectoralis Minor Length in Breast Cancer

Table 1. Figure 4 shows the Bland-Altman plot for the pectoralis

Participant Demographic Dataa minor length data. The mean difference between the
measures was −0.61 cm. The limits of agreement for the
PALM and Qualisys were 0.48 to −1.70 cm. The plots show

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Characteristic Value
Age, y a random scatter of points above and below the mean
difference line, showing agreement. Linear regression
Mean (SD) 61.6 (10.6)
(P > .05) revealed that there was no proportional bias.
Range 41–84 The calculated MDC95 for the PALM was 0.80 cm.
Height, cm
Mean (SD) 162.2 (7.45)
Discussion
Range 150–174
The purpose of this study was to examine the reliability
Weight, kg and validity of the PALM when measuring pectoralis
Mean (SD) 76.1 (15.5) minor length in women diagnosed with breast cancer. The
Range 53–124
results indicate that the PALM was able to accurately
measure pectoralis minor length with marginal error
BMI, kg/m2 , mean (SD) 29.1 (6.12)
when the arm is in a resting position in women diagnosed
Average time since surgery (SD), mo 14.8 (6.63) with breast cancer. The ability to objectively measure
Type of surgery pectoralis minor length using the PALM in women
diagnosed with breast cancer may allow rehabilitation
Mastectomy 7 (24)
professionals to determine restriction and/or changes in
Breast conserving 22 (76) the muscle and gain valuable information to help prevent
Stage of breast cancer and/or reduce shoulder impairments.
0 1 (3)
A variety of methods for measuring pectoralis minor
I 22 (76)
muscle length are commonly reported in the literature,
II 4 (14) but these are indirect measures of the muscle that either
III 2 (7) lack reported interrater reliability and validity44 or use
Type of lymph node dissection
expensive equipment to obtain the measure.11 As reported
by Host, pectoralis minor length was assessed in
SLND 28 (97)
participants with shoulder impingement by measuring the
None 1 (3) distance between the posterior acromion and a table with
Chemotherapy 3 (10) the person lying supine,44 a procedure described by
Kendall45 and Sahrmann.46 This methodology was also
Radiation 16 (55)
used in another study with 45 participants who had
Chemotherapy and radiation 6 (21) shoulder symptoms and 45 who were “healthy.”28
Hand dominance Although this study reported excellent intrarater reliability
Right 26 (90) for dominant and nondominant sides of the participants
without symptoms and for the pain-free and painful sides
Left 3 (10)
of participants with symptoms, interrater reliability and
Breast cancer on dominant side 15 (52) validity of this indirect measure was not reported.28 We
Reported lymphedema 3 (10) are aware of only 1 other study that measures pectoralis
Reconstruction after mastectomy 3 (43)
minor in women with breast cancer.11 Shamley et al used
MRI to determine muscle cross-sectional area of the
a
Data are reported as numbers (percentages) of participants unless pectoralis minor muscle in 74 women with unilateral
otherwise indicated. BMI = body mass index; SLND = sentinel lymph node
dissection. carcinoma of the breast.11 Although the interrater
reliability for the MRI measures was excellent (r = 0.89)
and MRI was able to detect a significant decrease in the
size of the pectoralis minor muscle on the affected side
and the unaffected arm (ICC[3,k] = 0.951; 95% CI = 0.897– (P = .026),11 this method is another indirect measure of
0.977; SEM = 0.19 cm). Intertester reliability was the muscle and the use of MRI is very expensive and not
also excellent43 for the affected arm (ICC[3,k] = 0.915; 95% clinically feasible for physical therapists.
CI = 0.81–0.962; SEM = 0.31 cm) and the unaffected arm
(ICC[3,k] = 0.945; 95% CI = 0.877–0.975; SEM = 0.22 cm). There have been a handful of published studies
There were significant correlations between pectoralis measuring pectoralis minor length using the PALM with
minor length measures between the PALM and the motion the same methodology as this current study, although
capture system for the affected (r = 0.87; P < .001) participants in these studies have all been overhead
and unaffected (r = 0.81; P < .001) arms (Fig. 3). athletes.32,47 To the best of our knowledge, a study by

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Pectoralis Minor Length in Breast Cancer

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Figure 3.
Values of pectoralis minor length measures using the PALpation Meter (PALM; Performance Attainment Associates, St Paul, MN, USA) and
Oqus 5+ (Qualisys AB, Gothenburg, Sweden) on the affected and unaffected arms.

Figure 4.
Bland-Altman plot for pectoralis minor muscle length (PML) data.

Rondeau et al is the only one that examines the reliability
and validity of the PALM.32 They measured pectoralis
minor length in 29 overhead athletes and found significant
correlations between measures using the PALM and an
electromagnetic motion analysis system on the dominant
(r = 0.695; P ≤ .005) and nondominant (r = 0.837;
P ≤ .005) arms.32 Although interrater reliability was not
assessed, intrarater reliability found the PALM to be
reliable and precise for both the dominant
(ICC[2,k] = 0.980; SEM = 0.32 cm) and nondominant
(ICC[2,k] = 0.990; SEM = 0.29 cm) arms.32 The excellent
intrarater reliability reported by Rondeau et al is similar to
what was found in this study. However, the present study
reported higher correlations when examining validity
between the PALM and the motion capture system
(Qualisys). It is important to note that the participants in
the study conducted by Rondeau et al used both males
and females, whereas we had only female participants
because emerging evidence suggests length differences
among genders.27 ,32 Additionally, the participants in the

6 Physical Therapy Volume 100 Number 3 2020


study by Rondeau et al were significantly younger
compared with those in the current study as inclusion
criteria reported participants who were healthy,
college-aged overhead athletes.32 Finally, in the study by
Rondeau et al, 3-dimensional coordinates were recorded
by an electromagnetic tracking system that uses sensors to
detect position in space,32 whereas a camera system was
used in the current study that is considered more accurate
because of its updated technology and resolution.25,27
The level of agreement between the PALM and the
Qualisys was limited according to the Bland-Altman plot.
However, as Giavarina reported, “the B&A [Bland-Altman]
plot method only defines intervals of agreements, it does
not say whether those limits are acceptable or not.”41 This
is significant, especially when examining clinical
measures. To understand our results in clinical terms, we
examined both the reported MDC for pectoralis minor
length in the literature and calculated our sample-specific
MDC95 . Rosa et al calculated the MDC for between-day
measurements in people with and without shoulder
impingement.26 They found a MDC95 for asymptomatic
individuals was 1.13 cm, whereas if participants were
symptomatic the MDC was 1.14 cm.26 The mean difference
found in the present study of −0.61 falls well below this
reported MDC95 by Rosa et al. Additionally, the calculated
MDC95 of 0.80 cm in the present study is larger than the
mean difference found when using the Bland-Altman
plot, again supporting the clinical applicability of the
measures.
To further emphasize the clinical meaning of
Bland-Altman, all of the measures fell within the limits of
agreement, and there is no relationship between
discrepancy and level of measurement as described by
Bunce.48 It is worth mentioning that, when comparing the
PALM and Qualisys, measured differences occurred; the
Qualisys may underestimate the pectoralis minor length
when compared to the PALM or the PALM could
overestimate the pectoralis minor length. This could be
due to a variety of limitations when using small reflective
markers near each other, as occurred in some cases for
the placement at the fourth intercostal space, as well as
having to place these markers on top of bony
prominences. Additionally, breast tissue and differences in
breast tissue volume (eg, a unilateral mastectomy) could
cause 1 of the markers to be angled differently. Because of
these limitations, the PALM may be a more valid measure
than the Qualisys when examining pectoralis minor
length in women with a history of breast cancer.
There are limitations to consider when interpreting the
results of this study. Possible errors with palpation may
occur in placing the reflective markers on bony landmarks
when using the Qualisys and when placing the PALM’s
caliper points on the landmarks on participants with
higher amounts of subcutaneous fat could exist.25,32,33
Another limitation may be the accuracy of the tracking
2020
Pectoralis Minor Length in Breast Cancer
system because of the proximity of the markers and
inherent volumetric restrictions.
Conclusions
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The PALM is an easy-to-administer and cost-effective tool
that can be used to measure pectoralis minor length in
women diagnosed with breast cancer. Because of the
variety of breast cancer treatments that can affect the
pectoralis minor, measuring pectoralis minor length may
be important for rehabilitation professionals. Because the
PALM was determined to be reliable, valid, and precise,
we recommend that this tool be used to measure
pectoralis minor length in women diagnosed with breast
cancer. Finally, future research could use the PALM to
examine whether deficits in pectoralis minor length in
women who have undergone treatment for breast cancer
affects function and quality of life as well as whether
differences occur because of cancer treatments such as
radiation and surgery type.
Author Contributions and Acknowledgments
Concept/idea/research design: S.E. Harrington, D. Katsavelis
Writing: S.E. Harrington, D. Katsavelis
Data collection: S.E. Harrington, J. Hoffman, D. Katsavelis
Data analysis: S.E. Harrington, J. Hoffman, D. Katsavelis
Project management: S.E. Harrington
Fund procurement: S.E. Harrington
Providing participants: S.E. Harrington
Providing facilities/equipment: S.E. Harrington
Consultation (including review of manuscript before submitting):
J. Hoffman
The authors thank Stacy Fritz, PT, PhD, for her contribution to the
Bland-Altman analysis and interpretation.
Ethics Approval
Prior to participation, all participants signed an informed consent
form approved by the Creighton University Institutional Review
Board.
Funding
This work was supported by the Dr George F. Haddix President’s
Faculty Research Fund of Creighton University (to S.E.H.).
Disclosures
The authors completed the ICMJE Form for Disclosure of Potential
Conflicts of Interest and reported no conflicts of interest.
DOI: 10.1093/ptj/pzz174
References
1 American Cancer Society. How common is breast cancer?
https://www.cancer.org/cancer/breast-cancer/about/how-
common-is-breast-cancer.html. Published 2019. Accessed
October 10, 2019.
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Pectoralis Minor Length in Breast Cancer
2 National Cancer Institute. Cancer stat facts: female breast
cancer. https://seer.cancer.gov/statfacts/html/breast.html.
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