Movement, Function, Pain, and Postoperative Edema in Axillary Web Syndrome

Linda A. Koehler; Anne H. Blaes; Tuffia C. Haddad; David W. Hunter; Alan T. Hirsch; Paula M. Ludewig

doi:10.2522/ptj.20140377

Abstract

Background Axillary web syndrome (AWS) is a condition that may develop following breast cancer surgery and that presents as a palpable axillary cord of tissue.

Objective The purposes of this study were: (1) to determine the clinical characteristics of AWS related to movement, function, pain, and postoperative edema and (2) to define the incidence of and risk factors for AWS within the first 3 months following breast cancer surgery.

Design This was a prospective cohort study with a repeated-measures design.

Methods Women who underwent breast cancer surgery with sentinel node biopsy or axillary lymph node dissection (N=36) were assessed for AWS, shoulder range of motion, function, pain, and postoperative edema (using girth measurements, bioimpedance, and tissue dielectric constant) at 2, 4, and 12 weeks. Demographic characteristics were used for risk analysis.

Results Seventeen women (47.2%) developed AWS, and AWS persisted in 10 participants (27.8%) at 12 weeks. Abduction range of motion was significantly lower in the AWS group compared with the non-AWS group at 2 and 4 weeks. There were no differences between groups in measurements of function, pain, or edema at any time point. Trunk edema measured by dielectric constant was present in both groups, with an incidence of 55%. Multivariate analysis determined lower body mass index as being significantly associated with AWS (odds ratio=0.86; 95% confidence interval=0.74, 1.00).

Limitations Limitations included a short follow-up time and a small sample size.

Conclusion Axillary web syndrome is prevalent following breast/axilla surgery for early-stage breast cancer and may persist beyond 12 weeks. The early consequences include movement restriction, but the long-term effects of persistent AWS cords are yet unknown. Low body mass index is considered a risk factor for AWS.

Footnotes

Dr Koehler, Dr Blaes, Dr Haddad, Dr Hirsch, and Dr Ludewig provided concept/idea/research design. Dr Koehler, Dr Blaes, Dr Haddad, Dr Hunter, and Dr Hirsch provided writing. Dr Koehler provided data collection. Dr Koehler, Dr Blaes, Dr Haddad, and Dr Ludewig provided data analysis and fund procurement. Dr Koehler and Dr Haddad provided project management. Dr Koehler, Dr Haddad, and Dr Ludewig provided study participants and facilities/equipment. Dr Blaes and Dr Ludewig provided institutional liaisons. Dr Blaes, Dr Haddad, Dr Hunter, Dr Hirsch, and Dr Ludewig provided consultation (including review of manuscript before submission). The authors acknowledge Ryan Shanley for his statistical contribution and Fairview Health Services, and they give a very special thanks to all of the patients who generously participated in the study.
This prospective cohort study with repeated-measures design was approved by the University of Minnesota Institutional Review Board.
This project was supported, in part, by the University of Minnesota Foundation, the Doctoral Dissertation Fellowship, and NIH P30 CA77598 utilizing the Masonic Cancer Center and University of Minnesota shared resources.