‘Patience is a virtue – Post-traumatic Axillary Web Syndrome - resolution without intervention
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Abstract
The current case report showcases an atypical symptomatic post-traumatic Axillary Web Syndrome in a 63-year-old Caucasian male patient with complete resolution of symptoms with no intervention. Axillary web syndrome is a condition where the skin area under the axilla becomes taut and on palpation there is a cord-like feeling similar to a guitar string, usually bound together as spider web appearance. The case report highlights the importance of appropriate physical examination and also the need for Community Diagnostic Centres and Point of Care Ultrasound services to help provide patients with timely diagnosis, reduce patient anxiety, and enhance patient experience and outcomes. The current case study is specifically useful for healthcare professionals working in primary care, especially in the National Health Service, where resources are already stretched to avoid unnecessary referrals, interventions and investigations. The case report is atypical since axillary web syndrome is typically and largely seen in cancer patients, specifically post breast cancer surgery in females and very rarely seen as a post traumatic presentation in acute setting.
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Axillary Web Syndrome, first contact practitioner, physiotherapy, breast cancer
Severeid K, Simpson J, Templeton B, York R, Hummel-Berry K, Leiserowitz A. Lymphatic cording among patients with breast cancer or melanoma referred to physical therapy. Rehab Oncol. 2007;25(4):8-13. doi: 10.1097/01893697-200725040-00002
Bergmann A, Mendes VV, de Almeida Dias R, et al. Incidence and risk factors for axillary web syndrome after breast cancer surgery. Breast Cancer Res Treat. 2012;131(3):987-992. doi: 10.1007/s10549-011-1805-7. PMID: 21987036.
Yeung WM, McPhail SM, Kuys SS. A systematic review of axillary web syndrome (AWS). J Cancer Surviv. 2015;9(4):576-598. doi: 10.1007/s11764-015-0435-1. PMID: 25682072.
Figueira PVG, Haddad CAS, de Almeida Rizzi SKL, Facina G, Nazario ACP. Diagnosis of Axillary Web Syndrome in Patients After Breast Cancer Surgery: Epidemiology, Risk Factors, and Clinical Aspects: A Prospective Study. Am J Clin Oncol. 2018;41(10):992-996. doi: 10.1097/COC.0000000000000411. PMID: 29045263.
Dinas K, Kalder M, Zepiridis L, Mavromatidis G, Pratilas G. Axillary web syndrome: Incidence, pathogenesis, and management. Curr Probl Cancer. 2019;43(6):100470. doi: 10.1016/j.currproblcancer.2019.02.002. PMID: 30898366.
Welsh P, Gryfe D. Atypical presentation of axillary web syndrome (AWS) in a male squash player: a case report. J Can Chiropr Assoc. 2016;60(4):294-298. PMID: 28065989; PMCID: PMC5178020.
Puentes Gutiérrez AB, García Bascones M, Puentes Gutiérrez R, Díaz Jiménez M. Síndrome axillary web idiopático [Idiopathic axillary web syndrome]. Rehabilitacion (Madr). 2020;54(1):68-72. Spanish. doi: 10.1016/j.rh.2019.10.002. PMID: 32007185.
Dündar Ahi E, Ozen S, Saraçgil Coşar SN. Idiopathic Axillary Syndrome: A Case Report on a Rare Entity. J Phys Med Rehab Sc. 2022;25(1). doi: 10.31609/jpmrs.2021-82996
Fukushima KF, Carmo LA, Borinelli AC, Ferreira CW. Frequency and associated factors of axillary web syndrome in women who had undergone breast cancer surgery: a transversal and retrospective study. Springerplus. 2015;4:112. doi: 10.1186/s40064-015-0889-7. PMID: 25793151; PMCID: PMC4359189.
Johansson K, Chong H, Ciornei CD, Brorson H, Mortimer PS. Axillary Web Syndrome: Evidence for Lymphatic Origin with Thrombosis. Lymphat Res Biol. 2020;18(4):329-332. doi: 10.1089/lrb.2019.0074. PMID: 31880509.
Reedijk M, Boerner S, Ghazarian D, McCready D. A case of axillary web syndrome with subcutaneous nodules following axillary surgery. Breast. 2006;15(3):411-413. doi: 10.1016/j.breast.2005.09.005. PMID: 16257525.
Rashtak S, Gamble GL, Gibson LE, Pittelkow MR. From furuncle to axillary web syndrome: shedding light on histopathology and pathogenesis. Dermatology. 2012;224(2):110-114. doi: 10.1159/000337210. PMID: 22508068.
Leduc O, Fumière E, Banse S, et al. Identification and description of the axillary web syndrome (AWS) by clinical signs, MRI and US imaging. Lymphology. 2014;47(4):164-176. PMID: 25915977.
Koehler LA, Hunter DW, Haddad TC, et al. Characterizing axillary web syndrome: ultrasonographic efficacy. Lymphology. 2014;47(4):156-163. PMID: 25915976; PMCID: PMC4518554.
Mullen LA, Harvey SC. Review of axillary web syndrome: What the radiologist should know. Eur J Radiol. 2019;113:66-73. doi: 10.1016/j.ejrad.2019.02.001. PMID: 30927961.
Koehler LA, Haddad TC, Hunter DW, Tuttle TM. Axillary web syndrome following breast cancer surgery: symptoms, complications, and management strategies. Breast Cancer (Dove Med Press). 2018;11:13-19. doi: 10.2147/BCTT.S146635. PMID: 30588087; PMCID: PMC6304256.
Lippi L, de Sire A, Losco L, et al. Axillary Web Syndrome in Breast Cancer Women: What Is the Optimal Rehabilitation Strategy after Surgery? A Systematic Review. J Clin Med. 2022;11(13):3839. doi: 10.3390/jcm11133839. PMID: 35807124; PMCID: PMC9267329.
da Luz CM, Deitos J, Siqueira TC, Palú M, Heck APF. Management of Axillary Web Syndrome after Breast Cancer: Evidence-Based Practice. Rev Bras Ginecol Obstet. 2017;39(11):632-639. English. doi: 10.1055/s-0037-1604181. PMID: 28701024.
Health Education England (2022) Community Diagnostic Centres (CDCs) and their role, NHS choices. NHS. Available at: https://www.hee.nhs.uk/our-work/cancer-diagnostics/community-diagnostic-centres-cdc (Accessed: January 21, 2023).
CSP (2022) Practice guidance for physiotherapists using point of care ultrasound (Pocus) in physiotherapy practice, The Chartered Society of Physiotherapy. Available at: https://www.csp.org.uk/publications/practice-guidance-physiotherapists-using-point-care-ultrasound-pocus-physiotherapy (Accessed: January 21, 2023).
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