Manual Lymph Drainage With Progressive Arm Exercises for Axillary Web Syndrome After Breast Cancer Surgery: A Randomized Controlled Trial

Abstract

Objective This study aimed to determine the effectiveness of a physical therapist–designed program tailored to axillary web syndrome (AWS) in women after breast cancer surgery. Methods A prospective, single-center, assessor-blinded, randomized controlled trial was conducted at the Physiotherapy in Women’s Health Research Unit of the Alcalá University (Madrid, Spain). Ninety-six women with AWS were assigned to the physical therapy group (manual lymph drainage using resorption strokes and arm exercises as if performing median nerve neurodynamic glide exercises with no neural loading; n = 48) or the control group (standard arm exercises; n = 48), with both groups receiving treatment 3 times a week for 3 weeks. Both interventions included an educational component. Results Compared with the control group, the physical therapy group showed significant and clinically relevant improvements in the primary outcome (self-reported pain intensity) at the primary and 3-month follow-ups. Significant and clinically relevant differences between groups were also found in the secondary outcomes (shoulder active range of motion, shoulder disability, and physical and functional aspects of health-related quality of life) at the primary follow-up and in the secondary outcomes as well as the trial outcome index at the 3-month follow-up. No significant differences were found at the 6-month follow-up in either primary or secondary outcomes. Conclusions The physical therapy program tailored to AWS was found to be effective for AWS symptoms in women after breast cancer surgery, both immediately after the program and after 3 months. Impact This is the first appropriately designed study to demonstrate the effectiveness of manual lymph drainage with progressive arm exercises for AWS. Clinicians and health service providers should consider how to provide survivors of breast cancer with AWS the opportunity to participate in physical therapy programs, including manual lymph drainage with progressive arm exercises. Lay Summary If you have axillary web syndrome following breast cancer surgery, your physical therapist can design a treatment program including manual lymph drainage and progressive arm exercises, which has been shown to result in reduced pain and improved motion compared with standard arm exercises.

A Case of Axillary Web Syndrome Caused by Venous Blood Sampling

“…This physical therapy protocol also resulted in no adverse events [10]. Torres-Lacomba et al compared physiotherapy with and without manual lymphatic drainage in an RCT and found that manual lymphatic drainage helped reduce pain [5]. It is expected that physiotherapy protocols for AWS after breast cancer surgery will become standardized in the future.…”

“…Although lymphatic involvement has been suggested, the detailed pathophysiology of AWS remains unclear [4,5]. In a study in which lymphoscintigraphy was performed in patients with AWS, it was reported that approximately 90% of the patients had changes such as decreased lymphatic function and obstruction of lymphatic vessels and 67% had collateral lymphatic vessels.…”

Axillary Web Syndrome in Breast Cancer Women: What Is the Optimal Rehabilitation Strategy after Surgery? A Systematic Review

“…In this scenario, rehabilitation might positively impact AWS prevention, pain management, and AWS treatment after BC surgery [27]. However, despite the wide variability of rehabilitative approaches proposed in the current literature, to date, the optimal rehabilitation strategies to manage AWS are far from being fully understood [26].…”