Lymphology/Lymphedema

Axillary web syndrome: Symptoms and treatment

Axillary web syndrome is a side effect that can develop after the removal of lymph nodes located under the armpits.

The condition involves the development of scarring or connected tissue under the arm.


Axillary web syndrome can be painful and limit the range of motion in the affected arm.







Cause of axillary web syndrome


Female cancer patient with male doctor.
The most frequent cause of axillary web syndrome is surgery for breast cancer. It is not known exactly why this complication occurs in some patients.


Axillary web syndrome most commonly occurs because of breast cancer surgery.


When surgery is recommended for breast cancer, it usually takes the form of a mastectomy or lumpectomy. These surgeries involve removal of the breast or a lump within the breast.


A sentinel node biopsy or axillary lymph node dissection is also often done to determine if cancer has spread beyond the breast. The lymph nodes in the armpit are the most likely place for breast cancer cells to spread, which is why the nodes are removed.


The difference between a sentinel node biopsy or axillary lymph node dissection is the number of lymph nodes removed.


The sentinel node is considered the first lymph node the tumor drains into. A sentinel node biopsy procedure only involves removing a few nodes.


An axillary node dissection involves removing several lymph nodes under the armpit. The exact number of lymph nodes removed may vary.



Axillary web syndrome can develop anywhere from several days to several weeks after surgery. In some cases, the syndrome can even develop months after surgery.


Doctors are not sure why some women develop the condition. One theory is that breast surgery may traumatize the blood vessels and connective tissue under the arm. The trauma causes inflammation, which eventually leads to hardening of the nearby soft tissue.


It is hard to say how common the condition is. There is not a lot of research on how many women develop axillary web syndrome after surgery for breast cancer.


Diagnosis often follows after a woman notices the web or cord-like scar tissue under her arm. It may also be found during a follow-up exam after surgery.


There are also instances when a woman may feel tightness or pain in the affected arm, but the scar tissue is not visible.






Symptoms


Senior woman having arm moved by nurse.
Pain and limited mobility are common symptoms of axillary web syndrome.


Axillary web syndrome is also called cording because the tissue that is visible under the skin resembles cord or rope.


Symptoms of axillary web syndrome can vary in severity and may include the following:


Scar tissue

Scar tissue forms under the arm where the nodes are removed. Although it can vary in thickness, the band of scar tissue is often easy to see and feel under the skin.


In some cases, the scarring extends from the armpit down the inner arm all the way to the elbow, wrist, or thumb. One long cord of scar tissue may develop, or several smaller cords may run down the arm.


Pain

Axillary web syndrome can be painful. The skin can feel stretched and tight.


If pain and tightness are present, a person’s natural reaction may be to limit movement in the painful arm. For example, they may avoid movements such as lifting their arms overhead.


Limiting movement to avoid pain can make the condition worse, as reduced movement in the affected arm can make the tissue tighter.


Decreased range of motion


The condition can cause a significant reduction in a person’s range of motion, which can interfere with their daily activities.


A person’s range of motion may be so limited that they cannot raise their arms overhead. Even simple tasks, such as getting dressed can be more difficult.






Treatment for axillary web syndrome

Although axillary web syndrome is not a life-threatening complication, it can interfere with a person’s quality of life.


If the condition is mild and not painful or affecting a person’s range of motion, treatment may not be needed. When treatment is recommended, it is used to release the scar tissue. Doing so should improve range of motion and reduce discomfort.


Depending on the extent of the scar tissue, treatment may only decrease tightness on one part of the cording. For example, if scar tissue runs from under the armpit to the wrist, treatment may improve the tissue under the arm, but the area near the elbow may still feel tight.


Treatment may include the following options:



Guided stretches

Doctors or physical therapists may recommend some stretches that people should do under medical guidance.


The specific stretches prescribed may vary depending on the extent of the scar tissue. One stretch is as follows:


  • lift the arms out to the sides and straighten the elbows
  • raise the hands until feeling a stretch
  • hold the stretch for about 30 seconds
  • repeat the stretch a few times, raising the arms a little higher each time

Holding the stretches for about 30 seconds is important. If the stretches are too brief, they will not be effective in lengthening the soft tissue and improving range of motion.




Massage


Woman having shoulder massaged.
Massage may help to treat the symptoms of axillary web syndrome. This should only be administered by someone trained in therapeutic massage for breast surgery patients.


Various massage techniques may be used to treat axillary web syndrome, such as nerve gliding and scar tissue release.


The different massage methods include manual manipulation of the connective tissue, which helps to break up scar tissue and improve a person’s range of motion.


Doctors are not exactly sure what happens to the scar tissue after it is broken down. The theory is that the scar tissue is reabsorbed by the body.


People should only receive this type of treatment from someone who specializes in therapy after breast surgery. A specialist has the expertise to perform the procedure correctly while avoiding damaging the tissue.



Laser therapy

A physical therapist may use a low-level laser to treat axillary web syndrome. Laser therapy involves the use of focused light directed into powerful beams to break up the hardened scar tissue.


Laser therapy may not be effective in all cases. For example, the effectiveness may depend on the thickness of the scar tissue. Some people may require multiple laser sessions.


Laser therapy may also have side effects; so always discuss the risks versus the benefits with a doctor before having the procedure.




Home care for axillary web syndrome

A medical professional with expertise in breast cancer rehabilitation may recommend home treatment. For example, they may suggest that the person performs the stretches they learned a few times a day at home.


Additional home treatment may include:


  • Nonsteroidal pain medication: Although pain medication will not decrease scarring or treat the underlying problem, it can reduce pain. Over-the-counter pain medication, such as acetaminophen, is often recommended.
  • Moist heat: Applying moist heat to the area may decrease discomfort. Always follow a doctor’s advice when using heat, as it can stimulate the production of lymph fluid, which may make the syndrome worse.


Prevention

There may be no way to prevent axillary web syndrome after breast cancer surgery. Following instructions after surgery, including recommended stretches, may help.


Women who develop the syndrome should ask their doctor if they need to continue to perform the stretches even after the condition has improved to prevent it from reoccurring.

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