Objective: To examine the effects of a scapula-oriented exercise on upper limb dysfunction in breast cancer survivors. Study design: A prospective randomized, controlled pilot trial with historical control. Setting: Rehabilitation department at a university hospital. Subjects: Thirty-two women with breast cancer were randomly assigned to scapula-oriented exercise group (n = 16) and general exercise group (n = 16). An historical control group (n = 18) without exercise was enrolled from breast cancer survivors. Interventions: The scapula-oriented exercises were designed focusing on scapulothoracic movement. The general exercise group performed body conditioning exercise. Exercise therapies were performed for one session per week for eight weeks. Main outcome measures: Pain and physical disabilities related to upper limb dysfunction, quality of life and depression were used as subjective outcomes. Objective outcome measures included shoulder range of motion and strength. Outcomes were assessed at baseline and post exercise. Results: At baseline, no significant difference was observed among the three groups. The scapula-oriented exercise group showed improvements in pain, physical function, social function, and global quality of life compared with baseline, whereas the general exercise group showed improved fatigue and range of motion. The change in global quality of life (P = 0.067; effect size, 0.33) and strength of external rotation (P = 0.001; effect size, 0.55) were significantly greater in the scapula-oriented exercise group than in the general exercise and control group. Conclusion: Scapula-oriented exercise had beneficial effects on pain, quality of life and aspects of strength. The sample size required in a larger definitive study is 32 subjects per group.