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Rehabilitation Practice and Science

Abstract

Axillary web syndrome (AWS), a complication primarily following breast cancer surgeries involving axillary lymph node dissection (ALND), presents as painful cords extending from the axilla, impairing shoulder mobility and potentially delaying cancer treatment. This review consolidates existing knowledge on AWS, covering its clinical presentation, risk factors, pathophysiology, and management strategies. AWS typically arises within weeks post-surgery but may develop later, manifesting as fibrous cords that hinder arm movement. Diagnosis relies primarily on clinical examination, and the reported incidence varies significantly across different populations and study designs. Risk factors include ALND, younger age, low body mass index, and adjuvant therapies. The pathogenesis of AWS remains unclear, though several theories suggest lymphatic and venous involvement through surgical disruption, fibrosis, and inflammation. While AWS is often self-limiting, it can persist in some cases, leading to chronic pain and an increased risk of lymphedema. Physical therapy is the most common management. Emerging treatments with percutaneous cord disruption and Xiaflex injection have shown promising results in a limited number of cases. Further research is needed to elucidate AWS mechanisms, develop standardized diagnostic tools, and validate new treatments, underscoring the need for multidisciplinary collaboration.

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