Axillary web syndrome: an overlooked cause of shoulder pain

Yıl 2019, Cilt: 44 Sayı: 1, 255 - 259, 31.03.2019

Bekir Tetik Kadir Songür Ayhan Aşkın

https://doi.org/10.17826/cumj.457220

Cited By: 1

Öz

Axillary
web syndrome (AWS) is a clinical syndrome that usually seen after surgical intervention
to axillary region. Fibrosis surrounded sclerotic vein and lymphatic tissue
(cording), can extends from axilla to arm and hand. AWS can limit off shoulder
range of motion (ROM) and can be the cause of shoulder pain. In the case we
share, it is noteworthy that any predisposing factor does not exist.
41-year-old male patient was admitted our outpatient clinic with pain and
feeling of tension on the right axilla which started 2 weeks ago during the
daily activities. On the physical examination there was a subcutaneous cord
that was visible from the right axillary region to the middle of the right arm.
His right shoulder movements were limited and painful. The patient was
prescribed oral nonsteroidal antiinflammatory drug (NSAID), electrotherapy program
and shoulder stretching/strengthening exercises. After 2 months, on the
re-examination, his right shoulder ROM was painless and in normal range; the
subcutaneous cording had completely recovered. Within our knowledge, our case
is the second case, whose etiology is unknown in the literature. Clinicians
should consider AWS, in differential diagnosis in patients with axillary
region/shoulder pain and shoulder ROM limitation. These patients may benefit
from appropriate combination therapies that include physical therapy modalities
and NSAIDs.

Anahtar Kelimeler

Axillary web syndrome, pain, cording, physical therapy

Aksiller web sendromu: omuz ağrısının gözden kaçan nedeni

Öz

Aksiller
web sendromu (AWS), genellikle aksiller bölgeye yapılan girişim sonrası
görülür. Fibrozis ile çevrelenmiş skleroze ven ve lenfatik dokular (kording)
aksilladan başlayıp, kola ve ele kadar uzanabilir. Omuz eklem hareket
açıklığını (EHA) kısıtlayan ve ağrıya sebep olabilen klinik bir durumdur.
Paylaşacağımız olguda ise mevcut bir predispozan faktörün olmayışı dikkat
çekicidir. İki hafta önce günlük aktivite sırasında sağ koltuk altında
gerginlik ve ağrı hisseden 41 yaşında erkek hasta polikliniğimize başvurdu.
Muayenesinde sağ aksiller bölgeden başlayıp sağ kol ortasına kadar uzanan gözle
görülebilen düzeyde cilt altı kord görünümü mevcuttu. Sağ omuz hareketleri
kısıtlı ve ağrılıydı. Hastaya oral non-steroidal antiinflamatuar ilaç (NSAİİ),
elektroterapi programı ve omuz germe/güçlendirme egzersizleri reçete edildi.
Hastanın 2 ay sonraki kontrol muayenesinde omuz EHA ağrısız, tam açıktı ve cilt
altındaki kord bulgusu tamamen düzelmişti. Bilgimiz dahilinde olgumuz
literatürdeki etiyolojisi bilinmeyen ikinci vakadır. Klinisyenlerin aksiller
bölgede ve omuzda ağrı, omuz EHA’da kısıtlılık olan hastalarda AWS’i ayırıcı tanıda
düşünmesi gerekmektedir. Bu hastalar uygun fizik tedavi modaliteleri ve
NSAİİ’ın kombine kullanıldığı tedavilerden fayda görebilmektedir.

Anahtar Kelimeler

Aksiller web sendromu, ağrı, kord, fizik tedavi

Kaynakça

• 1. Moskovitz AH, Anderson BO, Yeung RS, Byrd DR, Lawton TJ, Moe RE. Axillary web syndrome after axillary dissection. Am J Surg 2001;181:434-9.
• 2. Bourguignon D, Aktouf G, Coquerel D, Auquit-Auckbur I. Axillary web syndrome following axillary lymphnode dissection for melanoma: 5 cases. Ann Dermatol Venereol 2015;142:94-8.
• 3. Schuitevoerder D, White I, Fortino J, Vetto J. Axillary web syndrome: an under appreciated complication of sentinel node biopsy in melanoma. Am J Surg 2016;211:846-9.
• 4. McNeelML, Binkley JM, Pusic AL, Campbell KL, Gabram S, Soballe PW. A prospective model of care for breast cancer rehabilitation: postoperative and post reconstructive issues. Cancer 2012;118:2226-36.
• 5. ZhangQ, Tan C. Axillary web syndrome following granulomatous inflammation after folliculitis. Eur J Dermatol 2016;26:314-5.
• 6. Welsh P, Gryfe D. Atypical presentation of axillary web syndrome (AWS) in a male squash player: a case report. J Can Chiropr Assoc 2016;60: 294-8.
• 7. Demir Y, Güzelküçük Ü, Kesikburun S, Yaşar E, Tan AK. A rare cause of shoulder pain: axillary web syndrome. Turk J Phys Med Rehab 2017;63:178-80.
• 8. Rashtak S, Gamble GL, Gibson LE, Pittelkow MR. From furuncle to axillary web syndrome: shedding light on histopathology and pathogenesis. Dermatology 2012;224: 110-4.
• 9. Alvarez-Garrido H, Garrido-Ríos AA, Sanz-Muñoz C, Miranda-Romero A. Mondor’s disease. Clin Exp Dermatol 2009;34:753-6.
• 10. Yeung WM, McPhail SM, Kuys SS. A systematic review of axillary web syndrome (AWS). J Cancer Surviv 2015;9:576–98.
• 11. Torres Lacomba M, Mayoral Del Moral O, Coperias Zazo JL, Yuste Sánchez MJ, Ferrandez JC, Zapico Goñi A. Axillary web syndrome after axillary dissection in breast cancer: a prospective study. Breast Cancer Res Treat 2009;117:625-30.
• 12. Cheville AL, Tchou J. Barriers to rehabilitation following surgery for primarybreast cancer. J Surg Oncol 2007;95:409–18.
• 13. Josenhans E. Physiotherapeutic treatment for axillary cord formation following breast cancer surgery. Pt_Zeitschrift für Physiotherapeuten 2007;59:868–78.
• 14. Luz CMD, Deitos J, Siqueira TC, Palú M, Heck APF. Management of Axillary Web Syndrome after Breast Cancer: Evidence-Based Practice. Rev Bras Ginecol Obstet 2017;39:632-9.
• 15. Moreau A, Leduc O, Tinlot A, Clement A, Parijs T, Strappaert J. Axillary web syndrome: its features and the physical treatment plan of care. EJLRP 2010;21:25–8.
• 16. Fourie WJ, Robb KA. Physiotherapy management of axillary web syndrome following breast cancer treatment: Discussing the use of soft tissue techniques. Physiother 2009;95:314–20.
• 17. Hase K, Kamisako M, Fujiwara T, Tsuji T, Liu M. The effect of zaltoprofen on physiotherapy for limited shoulder movement in breast cancer patients: a single-blinded before-after trial. Arch Phys Med Rehabil 2006;87:1618–22.
• 18. Wei P, Zhu L, Chen K, Jia W, Hu Y, Su F. Axillary web syndrome following secondary breast-conserving surgery: a case report. World J Surg Oncol 2013;11:8.
• 19. Aydogan F, Belli AK, Baghaki S, Karabulut K, Tahan G, Uras C. Axillary web syndrome after sentinel node biopsy. Breast Care 2008;3:277–8.
• 20. Villamiel Campos E, Ramallo Alcover A, Killing Rodriguez I. Axillary web syndrome. Prog Obstet Ginecol 2008;51:745-8.