Axillary web syndrome: Incidence, pathogenesis, and management

Dinas, Konstantinos; Kalder, Matthias; Zepiridis, Leonidas; Mavromatidis, Georgios; Pratilas, Georgios Chrysostomos

doi:10.1016/j.currproblcancer.2019.02.002

Cited by 32 publications

(40 citation statements)

References 10 publications

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“…Besides, radiotherapy probably causes soft tissue fibrosis and radiation dermatitis, leading to shoulder pain and dysfunction. Other complications such as wound complications, lymphedema, and axillary web syndrome, on the other hand, can also induce shoulder function complications [ 10 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of free range-of-motion upper limb exercise based on mirror therapy on shoulder function in patients after breast cancer surgery: study protocol for a randomized controlled trial

Yuan

Wei

et al. 2021

Trials

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Background Shoulder function complications are common after treatment for breast cancer. Quite a few survivors still report a limited shoulder range of motion, even though the free range-of-motion upper limb exercise is helpful to restore shoulder function. Mirror therapy (MT) is a classical and effective rehabilitation technique to recover motor and sensory function for the limbs; in addition, studies have reported that MT has an influence on patients with shoulder functional dysfunction including increasing shoulder range of motion, improving shoulder function scores, and decreasing pain scores. Here, we describe a protocol of a randomized controlled trial to explore if free range-of-motion upper limb exercise based on MT has efficacy on shoulder function in survivors after surgery of breast cancer. Methods/design This is a prospective, single-blind, two-arm randomized controlled trial. An estimated 70 participants will be randomly allocated to (1) the MT group or (2) the control group. The participants in the control group receive free range-of-motion upper limb exercise, and participants in the MT group will engage in free range-of-motion upper limb exercise based on MT. The intervention will start on the first day after surgery and be completed at 8 weeks after surgery. The primary outcome in this protocol is shoulder range of motion (ROM), while the Constant-Murley Score (CMS); Disability of the Arm, Shoulder, and Hand Questionnaire (DASH); Tampa Scale of Kinesiophobia (13-item TSK); visual analog scale (VAS); grip strength; arm circumference; and lymphedema are the secondary outcomes. Assessment will be conducted before allocation (baseline) and at 2 weeks, 4 weeks, and 8 weeks after surgery. Discussion Based on the results that MT has an influence on shoulder function immediately after intervention in patients without nerve injury, this randomized controlled trial is to observe the efficacy of MT on shoulder function after a long-term intervention in breast cancer survivors. We look forward to the innovation of this study for both breast cancer rehabilitation and MT. Trial registration Chinese Clinical Trial Registry (ChiCTR) ChiCTR2000033080. Registered on 19 May 2020

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Section: Introductionmentioning

confidence: 99%

Effects of free range-of-motion upper limb exercise based on mirror therapy on shoulder function in patients after breast cancer surgery: study protocol for a randomized controlled trial

Yuan

Wei

et al. 2021

Trials

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“…Koehler et al [ 8 ] opined that AWS persists and that its clinical presentation appears in 59% of patients after BC surgery after 12 weeks, in contrast with Moskovitz et al, who reported spontaneous resolution at 3 months after surgery. Dinas et al [ 10 ] showed that rehabilitation was effective in recovering range of motion (ROM) of the shoulder and effecting cord resolution for up to 6–8 weeks, in accordance with Moskovitz and Leindeinus who underlined how shoulder mobilization and fascial mobilization exercises could accelerate the healing process and contain painful symptoms. Although there are no RCTs that compare physical therapy with placebo, physiotherapy is effective in reducing symptoms and recovering function, slowing AWS.…”

Section: Rehabilitation: Functional Recovery and Pain Managementmentioning

confidence: 73%

“…AWS is also called Mondor disease, attributed to superficial sclerosing venous thrombophlebitis [3][4][5]-the pathophysiology is angiolymphatic and fibrotic in origin, with lymphatic and fibroblastic involvement, and the cord can be exacerbated by tightness of the surrounding tissue [4][5][6][7]. The cording usually lies in the region of the axillary cavity and can extend along the medial surface of the upper arm and the ipsilateral lateral chest wall in 20% of cases [8], resulting in mechanical limitations in shoulder abduction; it is not uncommon that the cord extends to the forearm, occasionally reaching the radial tuberosity of the wrist [9,10].…”

Section: Introductionmentioning

confidence: 99%

Web Axillary Pain Syndrome—Literature Evidence and Novel Rehabilitative Suggestions: A Narrative Review

Agostini

Attanasi²,

Bernetti

et al. 2021

IJERPH

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Axillary web syndrome (AWS) is defined as a visible and palpable network of cords in the skin of the axillary cavity that are tensed by shoulder abduction following surgery for breast cancer, causing significant functional limits of the ipsilateral upper limb (UL) and pain. The purpose of this narrative review is to discuss rehabilitation approaches for greater efficacy with respect to pain and novel suggestions. AWS is a frequent complication of axillary lymphadenectomy that necessitates a thorough follow-up in the medium to long term. Physiotherapy is effective in the treatment of functional limb deficits, the management of pain, and the treatment of upper limb disability. The best management approach involves the use of soft tissue techniques to slow the natural course of the syndrome, in association with therapeutic exercises for functional recovery and muscle strengthening. AWS is linked secondary lymphedema, requiring integration with manual lymphatic drainage. The physiotherapy management of AWS is currently fragmented, and insufficient information is available on the nature of the disease. Thus, randomized and controlled studies that compare rehabilitation approaches in AWS are desirable, including the possibility of using mesotherapy in the treatment of axillary and upper limb pain.

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“…However, emerging data have demonstrated that AWS may persist longer than 12 weeks post surgery, and may even be diagnosed on follow-up after 18 months [23,26]. AWS is increasing being diagnosed in the postoperative rehabilitative setting, and it is important to understand the prevalence of AWS, so as to develop survivorship guidelines for patients with breast cancer in order to enable more effective social reintegration of patients and to limit surgical sequelae [27][28][29][30]. The aim of this study was to investigate the prevalence and associations for AWS in post-operative breast cancer patients up to 3 years after surgery in an outpatient community cancer rehabilitation program.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and associations of axillary web syndrome in Asian women after breast cancer surgery undergoing a community-based cancer rehabilitation program

Tay

Wong

2021

BMC Cancer

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Background Patients who have breast cancer surgery are at risk of axillary web syndrome (AWS), an under-recognized postsurgical complication which can result in shoulder morbidity and functional impairment. Emerging studies have indicated that AWS may persist beyond the first few months after surgery, although few studies have assessed the prevalence and association of AWS beyond a year after diagnosis. Therefore, the aim of this study was to investigate the prevalence and associations for AWS in post-operative breast cancer patients up to 3 years after surgery. Methods This cross sectional observational study was conducted at a community-based cancer rehabilitation center. Patients were evaluated for the presence of AWS via physical examination. Disease-related data was obtained from clinical review and medical records. Descriptive statistics were utilized to illustrate patient demographics and clinical characteristics. Logistic regression analyses were used to determine associations of AWS. Results There were 111 Asian women who were recruited, who had undergone breast surgery and were referred to a national outpatient rehabilitation center. The prevalence of AWS in this population was 28.9%. In the multivariate regression model, significant factors were age < 50 years (OR = 3.51; 95% CI = 1.12–11.0; p = 0.031) and ALND (OR = 6.54; 95% CI = 1.36–31.3; p = 0.019). There was reduced shoulder flexion ROM (p < 0.001) in patients with AWS compared to patients without AWS. Conclusions A high prevalence of AWS was reported in breast cancer survivors even at 3 years after breast surgery. Our findings highlight the need to identify breast cancer survivors with AWS even in the survivorship phase, and develop strategies to raise awareness and minimize functional impairment in these patients.

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Axillary web syndrome: Incidence, pathogenesis, and management

Cited by 32 publications

References 10 publications

Effects of free range-of-motion upper limb exercise based on mirror therapy on shoulder function in patients after breast cancer surgery: study protocol for a randomized controlled trial

Effects of free range-of-motion upper limb exercise based on mirror therapy on shoulder function in patients after breast cancer surgery: study protocol for a randomized controlled trial

Web Axillary Pain Syndrome—Literature Evidence and Novel Rehabilitative Suggestions: A Narrative Review

Prevalence and associations of axillary web syndrome in Asian women after breast cancer surgery undergoing a community-based cancer rehabilitation program

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