A technical report of postmastectomy axillary web syndrome symptom management using ultrasound-guided trigger point injections

Abstract

Axillary web syndrome (AWS) is a painful and difficult-to-manage complication of breast surgery with axillary lymph node dissection. Patients may believe that symptoms, including the presence of palpable axillary cords and reduced shoulder mobility, are a normal part of postoperative recovery. Both physician and patient education regarding this quality-of-life impairing condition is needed. In this report, we describe treating AWS using ultrasound-guided trigger point injections to avoid inadvertent damage to the neighboring lung, nerve, lymph nodes, and/or vasculature. There is limited information on their utility in treating AWS. At 4-month follow-up, our patient reported 70% improvement in her pain and discontinuation of her opioid medications, along with increased functionality. Ultrasound played a critical role in enhancing procedure accuracy and safety in zones that contain important nerve and vascular tissue and decreasing the risk of iatrogenic injury. While ultrasound was used historically for diagnostic purposes, we show why its use for interventions is on the rise.