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Mohammed J, Ash C, Rai J. 'Patience is a virtue' - Post-traumatic Axillary Web Syndrome - resolution without intervention. Arch Clin Cases 2023; 10:18-20. [PMID: 36814675 PMCID: PMC9940285 DOI: 10.22551/2023.38.1001.10233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
The current case report showcases an atypical symptomatic post-traumatic Axillary Web Syndrome in a 63-year-old Caucasian male patient with complete resolution of symptoms with no intervention. Axillary web syndrome is a condition where the skin area under the axilla becomes taut and on palpation there is a cord-like feeling similar to a guitar string, usually bound together as spider web appearance. The case report highlights the importance of appropriate physical examination and also the need for Community Diagnostic Centres and Point of Care Ultrasound services to help provide patients with timely diagnosis, reduce patient anxiety, and enhance patient experience and outcomes. The current case study is specifically useful for healthcare professionals working in primary care, especially in the National Health Service, where resources are already stretched to avoid unnecessary referrals, interventions and investigations. The case report is atypical since axillary web syndrome is typically and largely seen in cancer patients, specifically post breast cancer surgery in females and very rarely seen as a post traumatic presentation in acute setting.
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Affiliation(s)
- Jaleel Mohammed
- Lincolnshire Community Healthcare NHS Trust, Lincoln, UK,BUPA Health Clinics MSK Research & Audit Interest Group, UK,Correspondence: Jaleel Mohammed. Lincolnshire Community Healthcare NHS Trust, Beech House Witham Park, Waterside S, Lincoln LN5 7JH, UK.
| | - Catherine Ash
- Lincolnshire Community Healthcare NHS Trust, Lincoln, UK
| | - Jayanti Rai
- Kent Community Health NHS Foundation Trust, Kent, UK
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2
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Kahán Z, Szántó I, Dudás R, Kapitány Z, Molnár M, Koncz Z, Mailáth M. Breast Cancer Survivorship Programme: Follow-Up, Rehabilitation, Psychosocial Oncology Care. 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610391. [PMID: 35721327 PMCID: PMC9200958 DOI: 10.3389/pore.2022.1610391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023]
Abstract
Follow-up includes ongoing contact with and health education of the patient, surveillance and control of the adverse effects of surgery, oncological therapies or radiotherapy, screening of metachronous cancers, and comprehensive (physical, psychological and social) patient rehabilitation, which may be enhanced by a healthy lifestyle. Primary attention should be paid to early detection and, when needed, curative treatment of local/regional tumour recurrences. Similarly, with the hope of curative solution, it is important to recognize the entity of a low-mass and relatively indolent recurrence or metastasis (oligometastasis); however, there is still no need to investigate distant metastases by routine diagnostic imaging or assess tumour markers. Below there is a list of possible sources of support, with respect to adjuvant hormone therapy continued during long-term care, social support resources, pivotal points and professional opportunities for physical and mental rehabilitation. Individual solutions for specific issues (breast cancer risk/genetic mutation, pregnancy) are provided by constantly widening options. Ideally, a complex breast cancer survivorship programme is practised by a specially trained expert supported by a cooperative team of oncologists, surgeons, breast radiologists, social workers, physiotherapists, psycho-oncologists and psychiatrists. The approach of follow-up should be comprehensive and holistic.
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Affiliation(s)
- Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - István Szántó
- St. George's General Teaching Hospital, Székesfehérvár, Hungary
| | - Rita Dudás
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | - Mária Molnár
- Oncoradiology Centre, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Zsuzsa Koncz
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Mónika Mailáth
- Institute of Oncology, University of Debrecen, Debrecen, Hungary
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3
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Jeong S, Song BJ, Rhu J, Kim C, Im S, Park GY. A Risk Factor Analysis of Axillary Web Syndrome in Patients After Breast Cancer Surgery: A Single Center Study in Korea. Ann Rehabil Med 2021; 45:401-409. [PMID: 34743483 PMCID: PMC8572992 DOI: 10.5535/arm.21092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/12/2021] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To investigate the prevalence and risk factors of axillary web syndrome (AWS) in Korean patients. METHODS This retrospective study included a total of 189 women who underwent breast cancer surgery and received physical therapy between September 2019 and August 2020. We analyzed AWS and the correlation between the patients' demographics, underlying disease, type of surgery and chemotherapy or radiation therapy, and lymphedema. RESULTS The prevalence of AWS was found to be 30.6%. In the univariable analysis, age, chemotherapy, and hypertension were related to AWS. Finally, the multivariable logistic regression revealed that chemotherapy (odds ratio [OR]=2.84; 95% confidence interval [CI], 1.46-5.53) and HTN (OR=2.72; 95% CI, 1.18-6.30) were the strongest risk factors of AWS. CONCLUSION To the best of our knowledge, this was the first study that explored the risk factors of AWS in a Korean population after breast cancer surgery. As almost one-third of patients suffer from AWS after breast cancer surgery, it is essential to closely monitor the development of AWS in patients with hypertension or undergoing chemotherapy.
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Affiliation(s)
- Sangah Jeong
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Byung Joo Song
- Department of Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea
| | - Jiyoung Rhu
- Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Cheolki Kim
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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Tay MRJ, Wong CJ, Aw HZ. Prevalence and associations of axillary web syndrome in Asian women after breast cancer surgery undergoing a community-based cancer rehabilitation program. BMC Cancer 2021; 21:1019. [PMID: 34521359 PMCID: PMC8439086 DOI: 10.1186/s12885-021-08762-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/28/2021] [Indexed: 12/02/2022] Open
Abstract
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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Affiliation(s)
- Matthew Rong Jie Tay
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Singapore Cancer Society Rehabilitation Center, Singapore Cancer Society, Singapore, Singapore.
| | - Chin Jung Wong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Singapore Cancer Society Rehabilitation Center, Singapore Cancer Society, Singapore, Singapore
| | - Hui Zhen Aw
- Singapore Cancer Society Rehabilitation Center, Singapore Cancer Society, Singapore, Singapore
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Klein I, Kalichman L, Chen N, Susmallian S. A pilot study evaluating the effect of early physical therapy on pain and disabilities after breast cancer surgery: Prospective randomized control trail. Breast 2021; 59:286-293. [PMID: 34340163 PMCID: PMC8342784 DOI: 10.1016/j.breast.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background Morbidity of the shoulders after breast cancer (BC) surgery is a common side effect that includes; persistent pain, function limitation, and decreased range of motion (ROM). This study examines the effect of early physical therapy (PT) and patient's education on these morbidities. Methods A prospective, randomized clinical trial was conducted at a single medical center from October 2018 until April 2019. Women scheduled for breast cancer surgery were divided into intervention or control as standard care. The intervention included a PT treatment that included exercise instructions from the first postoperative day. Pain levels, upper limb function, ROM, and complications were measured. Results The study includes 157 women (mean age, 52.2 ± 12.9). Early PT reduced pain levels at the first month (NPRS 1.5 ± 1.2) and six months (NPRS 0.5 ± 0.8), compared with control (NPRS 2.1 ± 1.4, 1.0 ± 1.2), p = 0.019 and p = 0.011, respectively. Subdivision of the sample into small and extensive surgeries revealed additional positive effect for the intervention six months postoperatively on functional disabilities, p = 0.004 and p = 0.032 respectively. No complications attributable to the intervention were recorded. Conclusions Early PT and patient education reduces pain levels, and may improve function disabilities, without causing postoperative complications, although a larger study is needed to achieve unequivocal results. In breast cancer surgeries frequently delay the start of physical activities, arguing that it involves complications. The shoulder after breast surgery may provoke prolonged pain, disabilities, and prolongs recovery time. Physical therapy given the day after surgery, does not cause postoperative complications. Early onset of exercise regarding function and pain during recovery, may help reduce pain levels.
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Affiliation(s)
- Ifat Klein
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel; Department of Physical Therapy. Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Leonid Kalichman
- Department of Physical Therapy. Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Noy Chen
- Department of Physical Therapy, Assuta Medical Center, Tel Aviv, Israel
| | - Sergio Susmallian
- Department of Surgery, Assuta Medical Center, Tel Aviv, Israel; Faculty of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel.
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Effect of physical activity levels on oncological breast surgery recovery: a prospective cohort study. Sci Rep 2021; 11:10432. [PMID: 34002007 PMCID: PMC8129134 DOI: 10.1038/s41598-021-89908-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023] Open
Abstract
After breast cancer (BC) surgery, women may experience a physical decline. The effect of physical activity (PA) on the course of recovery after BC surgery has not yet been thoroughly examined. To analyze the impact of physical activity performed by women undergoing breast cancer surgery on measures of function, range of motion, and self-efficacy. A prospective study was carried out in 157 patients who underwent surgery for BC between October 2018 and April 2019, divided into four groups according to the intensity of PA with 6 months follow-up. 50 sedentary patients and 107 active patients were enrolled; the mean age was 52.6. Women who performed physical activity, moderate to vigorous, demonstrated lower function disabilities (QuickDASH 2.22) compared with inactivity or light physical activity (QuickDASH 7.0, p < 0.001), with better shoulder flexion (159.0° vs. 150.7°, p = 0.007) and abduction (159.5° vs. 152.2°, p = 0.008). Higher PA levels, displayed in higher self-efficacy reports (9.5 vs. 8.8, p = 0.002), and return to prior job status (0.005). The PA level does not influence pain at one, three and 6 months postoperatively (p = 0.278, p = 0.304 and p = 0.304 respectively). High PA levels increase the risk of axillary web syndrome (p = 0.041), although, it reduces the incidence of chronic pain (p = 0.007). Women who practice physical activity recover better from BC surgery than sedentary women. The higher the intensity and frequency of training, the better the results. Vigorous activity cause axillary web syndrome, despite, it has a beneficial effect on lowering the rate of chronic pain.
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Ryans K, Davies CC, Gaw G, Lambe C, Henninge M, VanHoose L. Incidence and predictors of axillary web syndrome and its association with lymphedema in women following breast cancer treatment: a retrospective study. Support Care Cancer 2020; 28:5881-5888. [PMID: 32270312 DOI: 10.1007/s00520-020-05424-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Axillary web syndrome (AWS) presents as a common postsurgical complication in individuals with breast cancer. Breast cancer-related lymphedema (BCRL) contributes to the shoulder and arm morbidity common in breast cancer survivors and often associated to cancer treatment. A paucity of literature exists evaluating the risk factors for developing AWS and the association between AWS and BCRL. The purposes of this study were (1) to identify risk factors for AWS in individuals with breast cancer, (2) to examine the association between BCRL and AWS, and (3) to determine if AWS increases the risk for developing BCRL. METHODS A retrospective study of 354 women who underwent breast cancer treatment and received physical therapy was included. RESULTS Axillary web syndrome developed in a third of women and predominately occurred in the first 8 postoperative weeks. The odds of AWS development were 73% greater for participants over the age of 60 (OR = 1.73, CI 95% 1.05-2.84). Women with AWS had 44% greater risk to develop lymphedema during the first postoperative year (RR = 1.44, CI 95% 1.12-1.84, p = 0.002). If AWS developed within the first postoperative month, women were almost 3 times more likely to develop lymphedema within the first 3 postoperative months compared with other women with AWS (RR = 2.75, CI 95% 1.199-6.310, p = 0.007). CONCLUSIONS Our findings suggest that 30% of breast cancer survivors will have AWS during the first year of survivorship. As institutions prioritize screening efforts, early postoperative prospective surveillance is needed for women over 60 due to high risk for AWS development and any women with AWS for increased risk of lymphedema development based on our findings.
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Affiliation(s)
- Kathryn Ryans
- Department of Physical Therapy, Mercy College, Dobbs Ferry, NY, USA. .,Department of Oncology Rehabilitation & Lymphedema Management, Atlantic Health System, Morristown, NJ, USA.
| | - Claire C Davies
- Nursing and Allied Health Research Office, Baptist Health Lexington, Lexington, KY, USA
| | - Gizela Gaw
- Department of Oncology Rehabilitation & Lymphedema Management, Atlantic Health System, Morristown, NJ, USA
| | - Caroline Lambe
- Department of Oncology Rehabilitation, Regional Cancer Center at Lee Health , Cape Coral, FL, USA
| | - Morgan Henninge
- Physical Therapy and Rehabilitation, United Health Services, Vestal, NY, USA
| | - Lisa VanHoose
- Department of Physical Therapy, University of Louisiana Monroe, Monroe, LA, USA
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8
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Axillary web syndrome: Incidence, pathogenesis, and management. Curr Probl Cancer 2019; 43:100470. [DOI: 10.1016/j.currproblcancer.2019.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/22/2019] [Indexed: 11/17/2022]
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9
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Ramírez-Parada K, Garay-Acevedo D, Mella-Abarca W, Petric-Guajardo M, Sánchez-Rojel C, McNeely ML, Leao-Ribeiro I, Fernández-Verdejo R. Axillary web syndrome among Chilean women with breast cancer: incidence and possible predisposing factors. Support Care Cancer 2019; 28:2941-2947. [PMID: 31768730 DOI: 10.1007/s00520-019-05190-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/12/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Breast cancer (BC) is the most common cancer in women worldwide. The main treatment for BC is surgery, which involves an axillary procedure that associates with the development of axillary web syndrome (AWS). The incidence of AWS among Chilean women with BC and its possible predisposing factors are currently unknown. Thus, we aimed to (1) determine the incidence of AWS among Chilean women with BC after surgery and (2) identify possible predisposing factors. METHODS Within 90 days post-surgery, patients were assessed for AWS, i.e., palpable or visible axillary cords in the axillary region extending down from the mid-axilla to the ipsilateral arm. We then computed the odds ratio with 95% confidence interval (OR [95% CI]) for having AWS considering the following predisposing factors: age, body mass index (BMI), number of lymph nodes removed, axillary procedure, days from surgery to the physical therapy assessment, hospital for the surgery, type of breast surgery, and neoadyuvant chemotherapy. RESULTS AWS was present in 49 out of 107 patients (45.8%). Younger age and lower BMI appeared as the sole predisposing factors for AWS (age, 0.95 [0.91-0.99]; BMI, normal weight 1.00, overweight 0.35 [0.11-1.12], obesity 0.28 [0.08-0.97]). CONCLUSION The incidence of AWS among Chilean women with BC was 45.8%. Our study also confirms data from previous reports showing that younger age and low BMI are associated with the development of AWS.
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Affiliation(s)
- Karol Ramírez-Parada
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Diana Garay-Acevedo
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Williams Mella-Abarca
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - César Sánchez-Rojel
- Departamento de Hemato-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Margaret L McNeely
- Department of Physical Therapy and Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
| | - Ivana Leao-Ribeiro
- Departamento de Kinesiología Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | - Rodrigo Fernández-Verdejo
- Carrera de Nutrición y Dietética, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Figueira PVG, Haddad CAS, de Almeida Rizzi SKL, Facina G, Nazario ACP. Diagnosis of Axillary Web Syndrome in Patients After Breast Cancer Surgery: Epidemiology, Risk Factors, and Clinical Aspects: A Prospective Study. Am J Clin Oncol 2019; 41:992-996. [PMID: 29045263 DOI: 10.1097/coc.0000000000000411] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Axillary web syndrome (AWS) is a complication after breast cancer surgery associated with the axillary approach. We defined a diagnosis tool as well as evaluated cord frequency, characteristics, and risk factors. METHODS A prospective cohort study of 173 women followed-up at Breast Diseases Division of Universidade Federal de São Paulo between July 2014 and September 2015 was established as an evaluation protocol to diagnose AWS. Sociodemographic status, anthropometric values, range of motion, comorbidities, pain, cord frequency, and characteristics (localization, number, palpable, and/or visible) among other data were collected at different time points before and after surgery. RESULTS The majority of the cords appeared by the seventh day (66.1%), and the total incidence of the cords was 90.9% at the 180th day. The axilla was the place for 80% of the occurrence of AWS, and >70% of the cords were palpable. Flexion and abduction of the shoulder showed reduced range of motion. Pain was present in 39.7% of the patients. Lymphadenectomy as well as hypertension were associated with increased risk of cord development; diabetes was associated with a decreased risk. CONCLUSIONS The evaluation protocol applied here showed a high incidence of AWS, with palpable cords more frequent than visible ones. The significance of hypertension and diabetes mellitus as risk factors for cord development in AWS should be evaluated in future studies. The evaluation protocol developed in this study seems to be of great importance for early detection of AWS and could also be valuable for future treatment planning.
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Mullen LA, Harvey SC. Review of axillary web syndrome: What the radiologist should know. Eur J Radiol 2019; 113:66-73. [PMID: 30927961 DOI: 10.1016/j.ejrad.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 11/19/2022]
Abstract
Axillary web syndrome is common after axillary surgery, frequently affecting breast cancer patients. In this condition, patients develop one or more linear bands of firm tissue, also known as "cords", in the axilla and arm, associated with pain and limited range of motion of the shoulder and arm. Radiologists may encounter this syndrome in patients referred for axillary or upper extremity ultrasound, and should be aware of the physical examination and ultrasound findings for accurate diagnosis. However, there are currently limited articles about this syndrome published in radiology journals, suggesting that radiologists may be unaware of this entity. In this work, axillary web syndrome will be discussed, including background knowledge, incidence, clinical presentation, possible etiology, and ultrasound appearance.
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Affiliation(s)
- Lisa A Mullen
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, 601 N. Caroline St., Suite 4120, Baltimore, MD, 21287, USA.
| | - Susan C Harvey
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medicine, 601 N. Caroline St., Suite 4120, Baltimore, MD, 21287, USA.
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12
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Harris SR. Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication. Breast Care (Basel) 2018; 13:132-135. [PMID: 29887791 PMCID: PMC5981636 DOI: 10.1159/000485023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The purpose of this review is to define axillary web syndrome (AWS) and describe its diagnosis and management. The following databases were searched through July 2017: PubMed, EMBASE (OvidSP), Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Cochrane Database of Systematic Reviews. Search terms included 'axillary web syndrome', 'axillary cording', and 'lymphatic cording'. 49 articles were identified; 8 did not relate to breast cancer, and 3 were not in English. Of the remaining articles, the majority were case reports, case series, or descriptive reviews. 2 systematic reviews were located as well as 1 randomized trial, 6 prospective cohort studies, and 2 retrospective cohort studies. Although a common sequela after axillary surgery for breast cancer staging, AWS has been poorly described in the medical literature as to the underlying pathophysiology, diagnosis, and management. Interventions range from patient education and simple reassurance that the syndrome will resolve spontaneously to active physical or manual therapies to maintain upper extremity range-of-motion, especially adequate motion for undergoing radiation therapy. Oncologists, breast surgeons, family physicians, and oncology nurse practitioners that work with patients with breast cancer should educate them about this prevalent complication and inform them preoperatively about what to anticipate.
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Affiliation(s)
- Susan R. Harris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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13
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Harder H, Holroyd P, Burkinshaw L, Watten P, Zammit C, Harris PR, Good A, Jenkins V. A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment. J Cancer Surviv 2017; 11:732-742. [PMID: 28741202 PMCID: PMC5671540 DOI: 10.1007/s11764-017-0630-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 07/10/2017] [Indexed: 12/03/2022]
Abstract
PURPOSE The study aim was to develop a mobile application (app) supported by user preferences to optimise self-management of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment. METHODS Focus groups with breast cancer patients were held to identify user needs and requirements. Behaviour change techniques were explored by researchers and discussed during the focus groups. Concepts for content were identified by thematic analysis. A rapid review was conducted to inform the exercise programme. Preliminary testing was carried out to obtain user feedback from breast cancer patients who used the app for 8 weeks post surgery. RESULTS Breast cancer patients' experiences with ULD and exercise advice and routines varied widely. They identified and prioritised several app features: tailored information, video demonstrations of the exercises, push notifications, and tracking and progress features. An evidence-based programme was developed with a physiotherapist with progressive exercises for passive and active mobilisation, stretching and strengthening. The exercise demonstration videos were filmed with a breast cancer patient. Early user testing demonstrated ease of use, and clear and motivating app content. CONCLUSIONS bWell, a novel app for arm and shoulder exercises, was developed by breast cancer patients, health care professionals and academics. Further research is warranted to confirm its clinical effectiveness. IMPLICATIONS FOR CANCER SURVIVORS Mobile health has great potential to provide patients with information specific to their needs. bWell is a promising way to support breast cancer patients with exercise routines after treatment and may improve future self-management of clinical care.
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Affiliation(s)
- Helena Harder
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
| | - Patrick Holroyd
- School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Lynn Burkinshaw
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Phil Watten
- School of Engineering and Informatics, University of Sussex, Brighton, UK
| | - Charles Zammit
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Peter R Harris
- School of Psychology, University of Sussex, Brighton, UK
| | - Anna Good
- School of Psychology, University of Sussex, Brighton, UK
| | - Val Jenkins
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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14
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Furlan C, Matheus CN, Jales RM, Derchain S, Sarian LO. Vascular Alterations in Axillary and Brachial Vessels in Patients with Axillary Web Syndrome After Breast Cancer Surgery. Lymphat Res Biol 2017; 16:287-293. [PMID: 28961070 DOI: 10.1089/lrb.2017.0037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Surgical manipulations of the axilla may cause a condition known as Axillary Web Syndrome (AWS). The systems compromised and the sequence of events leading to this syndrome remains unknown. This study evaluated clinical, surgical, and vascular factors associated with onset and duration of AWS after breast cancer surgery. METHODS AND RESULTS In this prospective study, 155 women were included. They were submitted to a physical examination that consisted of ultrasound Doppler of axillary and brachial vessels and the evaluation of AWS in 1, 3, and 6 months after breast cancer surgery. Women with advanced disease had a significantly higher incidence of AWS than those with early stage breast cancer (p = 0.02). In addition, women who underwent mastectomy or axillary lymph node dissection (ALND) had a significantly higher incidence of AWS in the 1-month (p < 0.01; p < 0.01) and 3-months (p < 0.01; p = 0.02) assessment rounds, respectively. The cross-sectional area of brachial artery was significantly smaller (p = 0.04) in women with AWS at the 3-months postoperative visit. The peak systolic velocity and the blood flow of the axillary artery was significantly higher in women with AWS 6 months after surgery (p < 0.03 and p = 0.02 respectively). CONCLUSION Our study confirm the combined changes of lymphatic and vascular systems in woman with AWS, since AWS was associated with more extensive dissection of axillary lymph nodes, compromised lymph nodes, and with abnormalities of the vascular parameters.
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Affiliation(s)
- Cintia Furlan
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Carolina Nascimben Matheus
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Rodrigo Menezes Jales
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,3 Radiology Sector, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Sophie Derchain
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
| | - Luís Otávio Sarian
- 1 Department of Obstetrics and Gynecology, State University of Campinas (Unicamp) , Campinas, São Paulo, Brazil .,2 Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM) , Unicamp, Campinas, São Paulo, Brazil
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Crane P, Ladden J, Monica D. Treatment of axillary web syndrome using instrument assisted soft tissue mobilization and thoracic manipulation for associated thoracic rotation dysfunction. Physiother Theory Pract 2017; 34:74-78. [PMID: 28854081 DOI: 10.1080/09593985.2017.1368755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE There is a paucity of research that investigates physical therapy management for patients with axillary web syndrome (AWS) and thoracic rotation dysfunction. The purpose of this case report is to describe the management of a patient with AWS and thoracic rotation dysfunction using an impairment-based approach that includes instrument assisted soft tissue mobilization (IASTM), thoracic manipulation, and stretching. CASE DESCRIPTION The patient was a 48-year-old female with a past medical history of bilateral breast cancer with a bilateral latissimus dorsi flap reconstruction. The patient was referred to physical therapy with chief complaints of right shoulder pain with reaching and an inability to resume running due to right shoulder and scapula pain. The patient was seen in outpatient physical therapy for four visits over four weeks. Treatment consisted of IASTM, thoracic manipulation, stretching exercises, and home exercise program instruction. OUTCOMES Upon discharge, the patient had improved right shoulder and thoracic range of motion, decreased pain, and improved function on the patient specific functional scale (PSFS). CONCLUSION Utilization of an impairment-based physical therapy approach to treat a patient with AWS and thoracic dysfunction yielded positive outcomes. Further research on the efficacy of IASTM and physical therapy management of AWS is warranted.
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Affiliation(s)
- Patricia Crane
- a MossRehab at Plymouth Meeting , Plymouth Meeting , PA , USA
| | - Jaclyn Ladden
- a MossRehab at Plymouth Meeting , Plymouth Meeting , PA , USA
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16
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Nieves Maldonado S, Pubul Núñez V, Argibay Vázquez S, Macías Cortiñas M, Ruibal Morell Á. Axillary web syndrome following sentinel node biopsy for breast cancer. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Nieves Maldonado SM, Pubul Núñez V, Argibay Vázquez S, Macías Cortiñas M, Ruibal Morell Á. Axillary web syndrome following sentinel node biopsy for breast cancer. Rev Esp Med Nucl Imagen Mol 2016; 35:325-8. [PMID: 27246290 DOI: 10.1016/j.remn.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/08/2016] [Accepted: 04/18/2016] [Indexed: 11/16/2022]
Abstract
A 49 year-old woman diagnosed with infiltrating lobular breast carcinoma, underwent a right mastectomy and sentinel node biopsy (SLNB). The resected sentinel lymph nodes were negative for malignancy, with an axillary lymphadenectomy not being performed. In the early post-operative period, the patient reported an axillary skin tension sensation, associated with a painful palpable cord. These are typical manifestations of axillary web syndrome (AWS), a poorly known axillary surgery complication, from both invasive and conservative interventions. By presenting this case we want to focus the attention on a pathological condition, for which its incidence may be underestimated by not including it in SLNB studies. It is important for nuclear medicine physicians to be aware of AWS as a more common complication than infection, seroma, or lymphoedema, and to discuss this possible event with the patient who is consenting to the procedure.
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Affiliation(s)
- S M Nieves Maldonado
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España.
| | - V Pubul Núñez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - S Argibay Vázquez
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - M Macías Cortiñas
- Servicio de Servicio de Ginecología y Obstetricia, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Á Ruibal Morell
- Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, España
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18
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Cuenca-González C, Herranz-Torrubiano AM, Berzal-Cantalejo MF, Flores-Torres I, Sayed-Avila S. [Doctor, why can't I move my arm? Axillary web syndrome]. Semergen 2015; 42:414-6. [PMID: 26321208 DOI: 10.1016/j.semerg.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/13/2015] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
Affiliation(s)
- C Cuenca-González
- Medicina Familiar y Comunitaria, Medicina Física y Rehabilitación, Servicio de Medicina Física y Rehabilitación, Hospital Clínico San Carlos, Madrid, España.
| | - A M Herranz-Torrubiano
- Medicina Familiar y Comunitaria, Centro de Salud Alameda de Osuna. Atención Primaria Este, Madrid, España
| | - M F Berzal-Cantalejo
- Medicina Familiar y Comunitaria, Especialista en Anatomía Patológica, Servicio de Anatomía Patológica, Hospital General Río Carrión, Palencia, España
| | - I Flores-Torres
- Medicina Física y Rehabilitación, Servicio de Medicina Física y Rehabilitación, Hospital La Inmaculada, Huércal-Overa, Almería, España
| | - S Sayed-Avila
- Medicina Física y Rehabilitación, Servicio de Medicina Física y Rehabilitación, Hospital Clínico San Carlos, Madrid, España
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