Background and Purpose:
The purpose of this paper is to describe a case of axillary web syndrome (AWS) in a client who had undergone a lumpectomy and sentinel node biopsy (SNB) for the treatment of breast cancer. The unique features of this case include extensive proximal webbing through the breast and trunk in addition to distal involvement that led to creative intervention strategies that will be described.
The client was a 44-year-old female diagnosed with invasive ductal carcinoma (IDC) with ductal carcinoma in situ (DCIS) who underwent wide excisional biopsy and sentinel node dissection. Within 10 days of surgery, she presented with AWS extending distally down the upper extremity and proximally through the breast and trunk wall. Physical therapy intervention included scar massage, soft tissue mobilization, myofascial release techniques, skin traction techniques, home stretches, and a two-person stretch release technique.
Outcomes were complicated by lack of measureable impairments and 35 sessions of radiation in the midst of treatment. Therapy techniques effectively reduced the cording but never completely eliminated it. Upper extremity function improved according to pre- and postassessment with the DASH (Disabilities of the Arm, Shoulder, and Hand) tool. The two-person technique was effective in reducing visibility of cords both proximally and distally.
Axillary web syndrome can extend both distally down the upper extremity and proximally through the breast and can be painful, restrictive, and debilitating. The results of this case study suggest that physical and occupational therapy techniques are effective in reducing and eliminating cording and improving overall functional use of the upper extremity. A two-person technique is recommended for cording extending both proximally and distally. Further research is also needed to determine the incidence of proximal cording and the long-term effectiveness of therapy intervention for AWS.