Axillary Web Syndrome: characterization of the different forms of clinical presentation of the cord.

ObjectiveDescribe and characterize the forms of presentation and manifestation of the cord present in the Axillary Web Syndrome.Materials and MethodsAfter a favorable opinion from the Research Ethics Committee of the Federal University of Goiás, the construction of items for the Axillary Web Syndrome Classification Scale began, based on the search for concepts involved in its diagnosis. The various steps of construction, application and validation of the instrument occurred from April 2020 to August 2021. The research took place at the outpatient clinic of Mastology at Hospital das Clínicas (Goiás). In the evaluation position: supine, upper limb ipsilateral to the breast operated in abduction, extension and external rotation of the shoulder, extension and supination of the elbow, extension of the wrist and fingers, information on the specific characteristics of the cord was recorded.ResultsThe means presented by the evaluators were almost identical for the variables related to the characterization of the cord, indicating a strong correlation, Cronbach's alpha was 0.894 for evaluator 1 and 0.879 for evaluator 2, indicating strong internal consistency. Inter-rater agreement was 100% (p>0.001) for almost all variables evaluated, with the lowest Kappa coefficient (0.77 p>0.001) for “Length”.ConclusionA consensus on classification criteria can be useful among researchers and practitioners. The fibrous cord classification items compiled in this study address its forms of presentation and manifestation and contribute to standardizing the assessment and classification of Axillary Web Syndrome.

A comprehensive approach to risk factors for upper arm morbidities following breast cancer treatment: a prospective study

Background Breast cancer surgery frequently causes deficiencies in shoulder functioning. The study pourpode is to identify risk factors for prolonged pain, reduction in function, and decrease in range of motion (ROM) in BC patients. Methods A prospective cohort study was designed in a private hospital; between October 2018 and April 2019 with a follow-up of 6 months. Patients following BC surgery, were divided by arm morbidities, and the different risk facrors were evaluated using univariate analysis and logistic regression. Results A total of 157 patients were included in the study. Risk factors for functional disabilities included; pain levels during hospitalization NPRS 1.2 (±0.8) compared to patients with no disabilities 0.5 ± 0.7 (p = .006), the size of tumors more than 1.4 ± 0.8 cm. compared with no morbidities 0.8 ± 0.9 cm. (p = .046), and breast reconstructions (p = .030). Risk factors for prolonged pain includes mastectomy (p = .006), breast reconstruction (p = .011), more than three dissected lymph nodes (p = .002), the presence of preoperative pain (p < .001), in-hospital pain (p < .001), axillary web syndrome (p < .001) and lymphedema (p < .001). Risk factors for decreased ROM were more than three dissected lymph nodes (p = .027), radiation (p = .018), and the size of dissected tissue (p = .035). Postoperative physical therapy appears to reduce the incidence of prolonged pain (p = .013) and regular physical activity may reduce long term functional disabilities (p = .021). Conclusions Upper arm morbidity following BC treatments affect up to 70% of the patients. Identifying the different risk and beneficial factors may improve awareness among physicians to refer patients to early rehabilitation programs and thus avoid chronic morbidity and improve the course of recovery. Trial registration The study was registered in Clinical trial with the ID number: NCT03389204.

A Risk Factor Analysis of Axillary Web Syndrome in Patients After Breast Cancer Surgery: A Single Center Study in Korea

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.

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

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.

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

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.

Therapeutic Effect of The Combination of Short-Term Massage Manipulation With Remote Guided Self-Exercise On The Post-Mastectomy Axillary Web Syndrome In Patients With Breast Cancer: A Randomized, Single-Blind Trial.

Background: Although the axillary web syndrome (AWS) is a common post-mastectomy complication. A small number of studies have reported treatment strategies for the AWS that showed interventions for one month were an effective strategy. The current study in AWS patients investigated the clinical efficacy of short-term massage manipulation (STMM) combined with remote guided self-exercise (RGS).Method: The patients were randomized into either short-term massage manipulation combine with remote guided self-exercise group (STMM+RGS group) or treatment without massage manipulation and remote guided self-exercise group (T- STMM+RGS group). STMM+RGS group received massage manipulation for 20 min per day for 7 days as total hospitalized therapy and then received telephone-guided therapy for 9 weeks, rehabilitation gymnastics provided during hospitalization.T- STMM+RGS group received rehabilitation gymnastics only. The primary outcome was changes in upper limb range of movement (ROM), assessed at 3, 6, and 9 weeks after intervention. The secondary outcomes were scores of visual analog scales (VAS), disability of arm, shoulder and hand (DASH) index, and activities of daily living (ADL) index assessed at 3, 6, 9 weeks of follow-up.Results: 106 patients were enrolled in the trial, 86 were randomized to treatment groups, with 79 completing the trial (41 in STMM+RGS group, 38 in T-STMM+RGS group). At 6 and 9 weeks of follow-up ROM had improved in STMM+RGS group compared with that observed in T-STMM+RGS group(p<0.05). This improvement was more pronounced and significantly different at 9 weeks(p<0.01).. There was also a significant difference in VAS at 6 and 9 weeks between the two groups. The DASH score improved significantly in STMM+RGS group compared with that in T-STMM+RGS group at 3, 6, and 9 weeks of follow-up(p<0.01), while the ADL score was significantly different (p<0.05) in the two groups at 3 and 6 weeks , but showed no significant difference after 9 weeks of follow-up.Conclusion: The combination of STMM and RGS improves upper limb ROM, relieves upper limb pain, and reduces the occurrence of disabilities in post-mastectomy patients with the AWS.

Quality of Life Interventions in Breast Cancer Survivors: State of the Art in Targeted Rehabilitation Strategies

: Breast cancer is the most common malignant tumor and the most prevalent cause of mortality in women. Advances in early diagnosis and more effective adjuvant therapies have improved the long-term survival of these patients. Pharmacotherapies and intrinsic tumor-related factors may lead to a wide spectrum of treatment-related disabling complications, such as breast cancer-related lymphedema, axillary web syndrome, persistent pain, bone loss, arthralgia, and fatigue. These conditions have a detrimental impact on the health-related quality of life of survivors. Here, we sought to provide a portrait of the role that rehabilitation plays in breast cancer survivors. Particular emphasis has been placed on recovering function, improving independence in activities of daily living, and reducing disability. This complex scenario requires a precision medicine approach to provide more effective decision-making and adequate treatment compliance.

Effect of physical activity levels on oncological breast surgery recovery: a prospective cohort study

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.