Physiotherapy management of axillary web syndrome following breast cancer treatment: discussing the use of soft tissue techniques.

BACKGROUND AND
PURPOSE: Axillary web syndrome (AWS) is becoming increasingly recognised as a sequela of breast cancer treatment. There are currently no formal guidelines on which to base therapy interventions. This case study discusses the physiotherapy management of a patient with AWS, highlighting a soft tissue mobilisation approach. CASE DESCRIPTION: A 47-year-old hairdresser experienced sudden loss of shoulder movement and development of axillary cords 22 days after mastectomy and axillary dissection. The management included manual therapy, mostly using soft tissue treatment techniques, combined with education and advice. OUTCOMES: Pre-morbid range of movement was achieved within 11 treatments, spread over 3 weeks. The patient returned to full-time employment after the seventh treatment by a physiotherapist, within 2 weeks of starting treatment, progressing to full range of shoulder movement with no cords or pain by 16 weeks post surgery. DISCUSSION: Previous theories on the pathophysiology of AWS may need to be revised. Physiotherapy intervention for these patients may prove beneficial in limiting subsequent shoulder dysfunction. Further research is needed to develop a standardised treatment approach for AWS.