Axillary web syndrome after axillary dissection in breast cancer: a prospective study

Abstract

International audienceThe axillary web syndrome is a self-limiting and frequently overlooked cause of significant morbidity in the early post-operative period after breast cancer axillary surgery, which is characterized by axillary pain that runs down the medial arm, limited shoulder range of motion affecting mainly shoulder abduction, and cords of subcutaneous tissue extending from axilla into the medial arm, made visible or palpable and painful by shoulder abduction. We evaluated the incidence of axillary web syndrome after axillary lymph-node dissection. Altogether 116 patients who underwent axillary lymph-node dissection were assessed for axillary web syndrome. Range of shoulder abduction, pain, and the subjective feeling of tightness along the arm were recorded. Axillary web syndrome was found in 56 patients, which means an incidence of 48.3% (CI95%: 38.9, 57.7). Axillary web syndrome is a significant self-limited cause of morbidity of axillary surgery ocurring not only in the early post-operative period

Dry needling — peripheral and central considerations

“…trigger point needling decreased the overall sensitivity in patients with fibromyalgia and decreased pain and increased range of motion in whiplash, post-mastectomy, and temporomandibular patients. 4,5,172,197 Patients with a hypersensitive trigger point in the upper trapezius muscle exhibited significantly enhanced somatosensory and limbic activity and decreased activity in the dorsal hippocampus compared with control subjects. 198 Using functional magnetic resonance imaging, Niddam et al showed that pain following the insertion of a needle into a trigger point combined with electrical stimulation is mediated through the periaqueductal gray in the brainstem.…”

Untitled

“…This condition is diagnosed clinically with physical exam revealing a web of palpable, cord like structures typically occurring several days to several weeks after surgery although it may present later [1][2]7,8]. In some cases the cords are not palpable, but the patient will endorse symptoms of pain and tightness while raising the arm [9].…”

Dynamic Angular Petrissage as Treatment for Axillary Web Syndrome Occurring after Surgery for Breast Cancer: a Case Report

“…(5,8,11,19,(23)(24)(25)(26) No standard of care has been established for the prevention or treatment of AWS. Manual therapies including myofascial release, scar massage, and lymphatic drainage techniques, as well as physical therapy, thermal therapy, surgery, and oral agents (anti-inflammatories and antibiotics (26) ) have been reviewed in detail by Yeung et al (8) Manual methods and physical therapy usually involve conservative treatment in several sessions over weeks or even months, with varying degrees of success in symptom reduction and cord resolution.…”

“…Manual therapies including myofascial release, scar massage, and lymphatic drainage techniques, as well as physical therapy, thermal therapy, surgery, and oral agents (anti-inflammatories and antibiotics (26) ) have been reviewed in detail by Yeung et al (8) Manual methods and physical therapy usually involve conservative treatment in several sessions over weeks or even months, with varying degrees of success in symptom reduction and cord resolution. (8,15,(18)(19)(23)(24)(25)27) Manual axial distraction with firm digital pressure applied at various points to rupture the cord (usually at the first session) successfully relieved pain and movement limitations in a series of patients, (12) but, as with most prospective studies and case reports, any negative consequences for healing and particularly for risk of lymphedema were not investigated. (8) This retrospective case report describes the use of specific therapeutic massage techniques, including Swedish massage with passive ROM, to relieve signs and symptoms of AWS over two treatment sessions in a young woman who had recently undergone mastectomy and axillary surgery for breast cancer.…”

“…(5)(6)(7)(8)10,(13)(14)(15)(16)(17) AWS is more common than generally appreciated, with reported prevalence as high as 85% of women receiving axillary surgery for breast cancer. (5)(6)(7)(8)10,(14)(15)(18)(19)(20) Risk factors may include younger age, lower body mass index, mastectomy, and greater numbers of lymph nodes removed. (8) Risk appears to be greater with either Levels I-II axillary dissection or axillary clearance (Level III dissection) than with sentinel lymph node biopsy alone, although not all investigators agree.…”