What is Axillary Web Syndrome: Causes, Symptoms, Treatment

Axillary Web Syndrome (Lymphatic cording)is a condition in which a soft tissue density develops on the axilla. It is basically a complication of a breast cancer surgery. Axillary Web Syndrome results in axillary pain and restricted shoulder range of motion. This condition generally develops approximately a month after a breast cancer surgery. Axillary Web Syndrome occurs when the lymph nodes from the armpits are removed during surgery^[1,2]

Post surgery there is development of scar tissue that affects the range of motion and causes pain in the armpits. Axillary Web Syndrome is a self-limiting condition and resolves spontaneously. However, during the healing phase is can cause severe physical and psychological morbidity in the affected individual.^[1,2]

There are also certain risk factors that increase the vulnerability of a female to Axillary Web Syndrome. These include but not limited to the extent of surgery, overall health status of the patient, age, body mass index, and healing complications that may occur post surgery.^[1,2]

Breast cancer surgery is the root cause of Axillary Web Syndrome, the surgical procedures done for a female with diagnosed breast cancer is either a mastectomy or a lumpectomy. These procedures involve removal of complete removal of the breast or removal of the tumor or lump from the breast. A sentinel node biopsy or an axillary lymph node dissection may also be performed. These procedures involve removal of lymph nodes from the armpit. This is because the cancer cells from the breast spread most likely to the lymph nodes in the armpit.^[2]

The sentinel node is one of the few nodes where the cancer spreads first and that is the reason they are removed. This is followed by removal of a large number of nodes from the armpits. Once this has been accomplished scarring takes place and within a few days after surgery there is a high likelihood of Axillary Web Syndrome developing.^[2]

Why this happens is somewhat of a mystery but one theory suggests the trauma of the surgery for breast cancer where even the lymph nodes in the armpits are removed cause inflammation resulting in Axillary Web Syndrome. Studies suggests that as many as 80% of females who undergo breast cancer surgery develop Axillary Web Syndrome after the procedure.

The symptoms of Axillary Web Syndrome may range in intensity from mild to severe. These include

Scar Tissue Formation: There is clear scar tissue formation at the site of the lymph node removal. The thickness of the scar tissue is variable but they can be easily felt under the skin. The scar tissue in some people may go down right to the wrist and elbows from the armpits. There have been some cases where the scar tissues have extended right down to the torso.^[2]

Pain: Axillary Web Syndrome is quite painful. This is because the swelling tends to stretch the skin and make it very tight causing pain. This is the reason why people are reluctant to move the affected arm. This leads to restricted mobility and ability to do daily chores with that arm. However, this makes the condition even worse due to tightening of the tissues due to non-use.^[2]

Restricted Range Of Motion: Axillary Web Syndrome can cause significant decrease in the range of motion of the arm. This interferes with the individual’s ability to carry out normal activities of daily living. The person may not be able to lift items or raise the arm overhead due to pain making tasks like putting on clothes difficult.^[2]

Axillary Web Syndrome is a self-limiting condition and poses no threat to the health of the individual. However, it can affect the quality of life of the patient significantly. If the condition is mild and does not cause much pain then just physical therapy and exercises are good enough to release the scar tissue and improving mobility of the arms.^[1,2]

The treatment for the scar tissue is often localized to the armpits and therefore if the scar tissue extends well below down to the elbow and wrists there may not be much improvement with regard to the tightness with the physical therapy directed towards the armpits and thus may require further treatment. The treatments for Axillary Web Syndrome include^[2]

Guided Stretches: These are quite easy and do not require any dedicated supervision. The person has to lift the arm to the sides and try and keep the elbows straight. Now he she has to raise the hand until a stretch or tension is felt. This position needs to be maintained for at least half a minute. The whole exercise needs to be repeated in sets of 10 with the aim of raising the arms higher with each attempt. It should be ensured that the stretch should be held for the prescribed amount of time as releasing it too soon may make the entire exercise futile.^[2]

Massage: Massage therapy is yet another effective way to treat Axillary Web Syndrome. Nerve gliding and scar tissue massage are the most favored techniques to achieve this. The massage will be done by a professional massage therapist and will work towards breaking the scar tissue and make the arms more mobile and normal.^[2]

Laser Therapy: At times, the physical therapist may make use of low level laser beams to treat Axillary Web Syndrome. The laser beams will break the scar tissue and normalize the functioning of the hands. It should be noted that laser therapy is no effective in all cases. The efficacy of laser beam treatment depends on the thickness of the scar tissue and this is the reason why some people may require multiple sessions of laser therapy to treat Axillary Web Syndrome. Additionally, laser beam treatment also has its inherent side effects. Thus it is important for patients to weight the risk benefit ratio before embarking on this treatment.^[2]

Home Care: Aside from the treatments mentioned above, there are also certain treatments that the patient can do at home to treat Axillary Web Syndrome. This includes use of NSAIDs for pain control. Applying moist heat over the affected area also calms down the pain and inflammation. However, using heat as a source of treatment may have a risk of increased production of lymph fluid which may make the symptoms worse. Thus, use of moist heat should only be done under the guidance of a physician as a potential source of treatment for Axillary Web Syndrome.^[2]

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