Axillary Web Syndrome Research Articles

A systematic review of axillary web syndrome (AWS)

Axillary web syndrome (AWS) can result in early post-operative and long-term difficulties following lymphadenectomy for cancer and should be recognised by clinicians. This systematic review was conducted to synthesise information on AWS clinical presentation and diagnosis, frequency, natural progression, grading, pathoaetiology, risk factors, symptoms, interventions and outcomes. Electronic searches were conducted using Cochrane, Pubmed, MEDLINE, CINAHL, EMBASE, AMED, PEDro and Google Scholar until June 2013. The methodological quality of included studies was determined using the Downs and Black checklist. Narrative synthesis of results was undertaken. Thirty-seven studies with methodological quality scores ranging from 11 to 26 on a 28-point scale were included. AWS diagnosis relies on inspection and palpation; grading has not been validated. AWS frequency was reported in up to 85.4 % of patients. Biopsies identified venous and lymphatic pathoaetiology with five studies suggesting lymphatic involvement. Twenty-one studies reported AWS occurrence within eight post-operative weeks, but late occurrence of greater than 3 months is possible. Pain was commonly reported with shoulder abduction more restricted than flexion. AWS symptoms usually resolve within 3 months but may persist. Risk factors may include extensiveness of surgery, younger age, lower body mass index, ethnicity and healing complications. Low-quality studies suggest that conservative approaches including analgesics, non-steroidal anti-inflammatory drugs and/or physiotherapy may be safe and effective for early symptom reduction. AWS appears common. Current evidence for the treatment of AWS is insufficient to provide clear guidance for clinical practice. Cancer survivors should be informed about AWS. Further investigation is needed into pathoaetiology, long-term outcomes and to determine effective treatment using standardised outcomes.

Syndrome de la corde axillaire après chirurgie ganglionnaire dans un contexte de mélanome : 5 cas

Axillary web syndrome is a rare disease similar to Mondor's disease and is usually seen after axillary surgery. Herein, we describe five new cases, all of which occurred in a setting of melanoma. Five patients presented axillary web syndrome following sentinel node surgery, adenectomy or axillary curettage in a setting of melanoma. Therapy involving analgesics and physiotherapy to snap the cord-like structure helped accelerate resolution. Some debate continues to surround the physiopathology of axillary web syndrome in the literature, particularly regarding its relationship with Mondor's disease, which is considered to result from superficial venous thrombosis. The lymphatic and myofascial explanation for the syndrome appears to us to be more coherent and justifies the non-aggressive therapeutic approach we adopt for our patients, who receive assurances about the benign nature of their condition and the absence of sequelae. Axillary surgery in patients presenting melanoma appears to be a risk factor for axillary web syndrome. No relationship has as yet been demonstrated between this syndrome and the presence of axillary metastases.

Axillary web syndrome self-assessment questionnaire: Initial development and validation

IntroductionDespite the great strides made in medical knowledge, surgery still remains a necessary part of the breast cancer treatment. Surgical procedures still lead to post surgical sequelae. The axillary web syndrome (AWS) is one such sequela, which can lead to disability, reduced arm mobility and compromised quality of life. It is often unidentified and the literature regarding its assessment is limited.To improve diagnosis and patient education, the Screening Test AWS (ST-AWS) questionnaire was drafted and applied at the European Institute of Oncology (EIO). Materials and methodWe prospectively recruited patients from October 2012 to December 2012. Patients who underwent sentinel lymph node biopsy and/or axillary dissection procedures were registered. Physical examination was set as a gold standard. Results88 patients completed the questionnaire. Among these, 32 patients had axillary web syndrome diagnosed, thus a 36% incidence.The questionnaire achieved a sensitivity of 94%, a specificity of 91%, a positive prevalence value (PPV) of 86%, a negative prevalence value (NPV) of 96% and an accuracy of 92%. ConclusionOur questionnaire achieves high sensitivity and predictive values, and we would recommend it as a screening-tool for auto-diagnosis of the AWS.The main objective of the questionnaire is to enhance patient and therapist awareness of the problem, and prompt management to shorten the effects of this disability. Moreover, it may offer a tool to enhance body image acceptance after surgery.Further studies whereby the efficacy of the questionnaire is investigated in a larger, heterogeneous group and in different situations are warranted.

Shoulder and arm morbidity in sentinel node-negative breast cancer patients: a systematic review

The purpose of this study was to assess which shoulder and arm impairments are common in sentinel node-negative breast cancer patients and to describe the incidence and time course of these impairments. A systematic literature search was performed using different electronic databases until October 2013. Inclusion criteria were (1) research studies that included breast cancer patients surgically treated using the sentinel lymph node biopsy (SLNB) technique, (2) sentinel node-negative patients, and (3) studies that investigated morbidities of shoulder and/or arm. The exclusion criteria were (1) reviews or case studies, (2) patients who have had a SLNB followed by an axillary lymph node dissection (ALND), (3) results of ALND patients and SLNB patients were not described separately, and (4) no follow-up described. Thirty articles were included, representing 5,448 patients. Shoulder and arm impairments among sentinel node-negative patients are loss of mobility, loss of strength, pain, axillary web syndrome, and sensory disorders. Within the first month after SLNB, the morbidities with the highest incidence are decreased abduction (range 40.8-100 %), forward flexion of the shoulder (range 37-100 %), pain (range 3.4-56.6 %), and numbness (range 2-64 %). Morbidities with the highest incidence after 2 years are pain (range 5.6-51.1 %), numbness (range 5.1-51.1 %), loss of strength (range 0-57.7 %), decreased internal rotation (44.4 %), and decreased abduction (range 0-41.4 %). In conclusion, although the shoulder and arm impairments are less common after SLNB alone compared to ALND, they cannot be neglected. A considerable amount of patients still suffer from those impairments more than 2 years after surgery.

Therapistsʼ Perspectives and Interventions in the Management of Axillary Web Syndrome: An Exploratory Study

Therapistsʼ Perspectives and Interventions in the Management of Axillary Web Syndrome: An Exploratory Study

Abstract P3-09-06: Development and validation of a questionnaire for axillary web syndrome self-assessment

Abstract INTRODUCTION: Despite the great strides made in medical knowledge and technology, surgery still remains a necessary part of the breast cancer treatment protocol. Even with the employment of less aggressive techniques, surgical procedures still lead to post surgical sequelae and complications. The axillary web syndrome (AWS) is one such sequela which can lead to disability, reduced arm mobility and compromised quality of life. Currently, there is no diagnostic tool such as a self-validated questionnaire to detect AWS which may help the patient to seek the opportunity for immediate treatment. To improve diagnosis and patient education, the ST-AWS questionnaire was drafted and applied at the European Institute of Oncology (IEO). MATERIALS AND METHOD: We prospectively recruited patients from October 2012 to December 2012. Groups of patients who underwent ipsilateral sentinel lymph node biopsy and/or axillary dissection with or without plastic reconstruction procedures were registered. The complete physical examination by physiotherapist was set as a gold standard to evaluate the validity and reliability of ST-AWS. Axillary Web Syndrome general table AWS EVALUATION CATEGORIESYES 32 (%)NO 56 (%)p-value §AGE*< 5119 (59)24 (43)0.14 ≥ 5113 (41)32 (57) SCHOOLINGHigh28 (88)42 (75)0.16 Low4 (12)14 (25) BMI≤ 18,55 (16)0 (0)0.006 18,5 - 25,022 (68)32 (57) > 255 (16)24 (43) TIME OF SURGERY (min)*≤ 11912 (37)33 (59)0.05 > 11920 (63)23 (41) PLASTIC RECONSTRUCTIONYes25 (78)29 (52)0.02 No7 (22)27 (48) BREAST SURGERYMastectomy25 (78)34 (61)0.10 Quadrantectomy7 (22)22 (39) AXILLARY SURGERYAxillary Dissection20 (63)29 (52)0.33 Sentinel Lymph Node Biopsy12 (37)27 (48) N STAGE09 (28)25 (45)0.07 115 (47)16 (28) 22 (6)10 (18) 36 (19)5 (9) SENSIBILITY LOSSYes15 (47)9 (16)0.002 No17 (53)47 (84) * median values were used as cut off points § Chi-square, Fisher exact and Mantel-Haenszel Chi-Square tests RESULTS: 88 patients completed the questionnaire and the physical examinations and were included in the study. 32 patients had axillary web syndrome diagnosed, thus a 36% incidence. Median age was 51 years (range 22-78 years). The questionnaire achieved a sensitivity of 94%, a specificity of 91%, a positive prevalence value (PPV) of 86%, a negative prevalence value (NPV) of 96% and an accuracy of 92%. Comparing Gold Standard physical Evaluation and ST-AWS Questionnaire results PHYSICAL EVALUATION (GOLD STANDARD) NEGATIVEPOSITIVETOTALQUESTIONNAIRE NEGATIVE51253POSITIVE53035TOTAL563288Sensibility: 94%, Specificity: 91%, Accuracy:92%, PPV:86%, NPV:96% CONCLUSION: Our questionnaire achieves high sensitivity and predictive values, and we would recommend it as a screening-tool for auto-diagnosis of the axillary web syndrome. Nevertheless, the results of the ST-AWS should be confirmed by a physiotherapy examination. The main objective of the questionnaire is to enhance patient and therapist awareness of the problem, and prompt management in order to shorten the effects of this disability. Moreover, it may offer a tool to enhance body image acceptance after surgery. Further studies whereby the efficacy of the questionnaire is investigated in a larger, heterogeneous group and in different situations are warranted. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-06.

Axillary web syndrome after transaxillary robotic thyroidectomy.

Axillary web syndrome is a self-limiting and frequently overlooked complication in the early postoperative period of axillary surgery. This entity has been described in breast cancer patients after axillary lymph node dissection. Robot-assisted transaxillary thyroidectomy is now becoming increasingly popular in part owing to the desire to avoid an obvious cervical scar. This procedure is a kind of axillary surgery, but there has been no report about axillary web syndrome after robotic transaxillary thyroidectomy. Here, we report on a 47-year-old female with axillary web syndrome after robotic transaxillary thyroid lobectomy.

Complication Rates in Patients With Negative Axillary Nodes 10 Years After Local Breast Radiotherapy After Either Sentinel Lymph Node Dissection or Axillary Clearance

We assess complication rates in node negative breast cancer patients treated with breast radiotherapy (RT) only after sentinel lymph node dissection (SLND) or axillary lymph node dissection (ALND). Between 1995 and 2001, 226 women with AJCC stage I-II breast cancer were treated with lumpectomy, either SLND or SLND+ALND, and had available toxicities in follow-up: 111/136 (82%) and 115/129 (89%) in SLND and ALND groups, respectively. RT targeted the breast to median dose of 48.2 Gy (range, 46.0 to 50.4 Gy) without axillary RT. Chi-square tests compared complication rates of 2 groups for axillary web syndrome (AWS), seroma, wound infection, decreased range of motion of the ipsilateral shoulder, paresthesia, and lymphedema. Median follow-up was 9.9 years (range, 8.3-15.3 y). Median number of nodes assessed was 2 (range, 1-5) in SLND and 18 (range, 7-36) in ALND (P < 0.0001). Acute complications occurred during the first 2 years and were AWS, seroma, and wound infection. Incidences of seroma 5/111 (4.5%) in SLND and 16/115 (13.9%) in ALND (P < 0.02, respectively) and wound infection 3/111 (2.7%) in SLND and 10/115 (8.7%) in ALND (P < 0.05, respectively) differed significantly. AWS was not statistically different between the groups. At 10 years, the only chronic complications decreased were range of motion of the shoulder 46/111 (41.4%) in SLND and 92/115 (80.0%) in ALND (P < 0.0001), paresthesia 12/111 (10.8%) in SLND and 39/115 (33.9%) in ALND (P < 0.0001), and lymphedema assessed by patients 10/111 (10.0%) in SLND and 39/115 (33.9%) in ALND (P < 0.0001). Chronic lymphedema, assessed by clinicians, occurred in 6/111 (5.4%) in SLND and 21/115 (18.3%) in ALND cohorts, respectively (P < 0.0001). Our mature findings support that in patients with negative axillary nodal status SLND and breast RT provide excellent long-term cure rates while avoiding morbidities associated with ALND or addition of axillary RT field.

Axillary web syndrome following secondary breast-conserving surgery: a case report

BackgroundAxillary web syndrome is a cause of significant morbidity in the early postoperative period after axillary surgery.Case presentationA patient developed axillary web syndrome after secondary breast surgery and recovered in 3 weeks through physical therapy and using Aescuven Forte.DiscussionThe pathogenesis of axillary web syndrome is not clear. It is reported that axillary surgery is the main cause. The presented case indicates that tissue injury might be an important cause of axillary web syndrome. Though axillary web syndrome is self-limiting, special physical therapy and Aescuven Forte can shorten the natural duration.ConclusionSecondary breast surgery could cause axillary web syndrome. Physical therapy and Aescuven Forte could shorten the duration of the self-limited morbidity.

Incidence complications following sentinel lymph node biopsy or axillary lymph node dissection after breast cancer surgery.

97 Background: To reduce arm morbidity the sentinel lymph node biopsy was implemented in the breast cancer treatment. The aim of this study was to investigate the arm morbidity after sentinel lymph node biopsy or axillary lymph node dissection. Methods: This is a prospective cohort study of women who underwent surgical treatment of breast cancer at a single institution. Arm and shoulder morbidity were measured before, 1 and 6 months after the operation. Analyses were performed to compare morbidity between sentinel lymph node biopsy (SLND) and axillary lymph node dissection (ALND). This study obtained approval from the National Cancer Institute research and ethics committee. Results: Were included 203 patients and, during the study, 6 were excluded and there was 23 losses of follow-up. The average age of women was 58 years (DP=13). SLND was made in 31,6% with an average of 3 lymph nodes removed. Among those submitted to ALND, the average lymph node removed was 18 (p&lt;0.0001). After 45 days of surgery, the incidence of arm morbidity was: 23% of shoulder restriction (ALND 22%, SLND 1%, p&lt;0.001); 28% of axillar web syndrome (ALND 24%, SLND 4%, p&lt;0.001); 38% of seroma (ALND 32%, SLND 6%, p&lt;0.001); 5% of arm edema (ALND 4%, SLND 1%, p&lt;0.001). In the final evaluation occurred 6 months after the surgery, it was observed de following incidence: 4% of shoulder restriction (ALND 3%, SLND 1%, p=0.371); 18% of arm pain (ALND 12%, SLND 6%, p=0.460); 18% of axillar web syndrome (ALND 16%, SLND 2%, p&lt;0.002); 5% of arm edema (ALND 4%, SLND 1%, p=0.417). Conclusions: After 45 days of surgery, patients with SLND has less arm morbidity compared with patients submitted to ALND. After 6 months, it was observed less incidence of arm symptoms and only axillary web syndrome were more incident in patients with axillary dissection.

Incidence and risk factors for axillary web syndrome after breast cancer surgery

The objective of the study is to estimate the incidence and risk factors of axillary web syndrome (AWS) in early postoperative period (45days). From the prospective cohort of women undergoing breast cancer surgery, we collected the variables related to patient characteristics, treatment, tumor, and postoperative complications. We performed bivariate and logistic regression. A total of 193 patients are included with a mean age of 58.26years, majority of which are women who are overweight or obese (72.3%). The incidence of AWS was 28.1%. The presence of pain in the ipsilateral upper-limb associated with AWS was reported in 5.4% of the patients, and the shoulder joint restriction was observed in 11.4%. When controlling for confounding between AWS and the factors that showed statistical significance in bivariate analysis, the variables that explain the occurrence of the AWS were the type of axillary surgery, where women who underwent sentinel lymph node biopsy showed 68% less risk compared with those that underwent axillary lymphadenectomy (AL) (RR=0.32; 95% CI, 0.13-0.79; P value=0.014) and numbness in the arm after an injury of the intercostobrachial nerve, which is 3.19 times the risk of the AWS (RR=3.19; 95% CI, 1.40-7.29, P value=0.006). From the above findings, we concluded that the incidence of AWS was 28.1%, and it was associated with AL and numbness in the arm after injury of the intercostobrachial nerve.

El síndrome Axillary-web: «frecuente, pero infradiagnosticado»

We present one case of Axillary-web syndrome (AWS) seen in Granollers Hospital (Barcelona). AWS is one of the most frequently overlook complications following axillary dissection.AWS appears in the early postoperatory period. It consists of subcutaneous tissue cords extending from the axilla into the medial part of the arm, with axillary pain and limited mobility of the shoulder.There are very few articles and reviews in the scientific literature on this syndrome. In addition, the incidence found is variable, depending on whether it refers to axillary dissection (from 6-72%) or simply the sentinel node technique (0.5-20%).Lack of knowledge about AWS may lead to confusion between limited mobility, muscle shortening or pain with movement that can appear after an axillary dissection. This could result in the proposal of complementary tests or erroneous treatments or provoke delay in beginning radiotherapy.

QUALITY OF LIFE AND THE RELATIONSHIP WITH EARLY COMPLICATIONS OF BREAST CANCER TREATMENT IN BRAZILIAN WOMEN

Background and Aims: The assessment of quality of life (QOL) in women with breast cancer before treatment allows a more comprehensive assessment these patients. Some initial complications are a major cause of morbidity in the postoperative period. The aim of this study was to evaluate the association between quality of life before treatment of breast cancer and early complications in National Cancer Institute-Brazil (INCA). Methods: Participants were women with unilateral breast cancer, requiring oncological attention in INCA between June/2009 and March/2010. To assess quality of life before treatment was used EORTC QLQ-C30 and the BR23 module. Information about early changes (axillary web syndrome, pain and subjective symptoms related to early edema in the upper limbs) were obtained by physical examination 30 days after surgery and were collected in a standardized form of the medical records. Bivariate analysis of dichotomous variables and independent variables and the odds ratio, with CI 95%, were analyzed. Results181 women were evaluate and were observed that women who reported good health overall, showed a protection of 57% for early subjective edema (OR=0.43 95% CI 0.20 -0.96). Symptoms scale of BR23 is negatively associated with pain (OR=0.11 95% CI 0.21-0.73). Patients with good functionality-C30 showed protection of 66% (OR=0.34 95% CI 0.15-0.75) for pain. Were not found statistically significant results when evaluating axillary web syndrome and does not indicate the presence of association. Conclusions: These results suggest that good quality of life is predictor to evaluated early complications in women with breast cancer in the period before starting cancer treatment.

P2-80 Early complications of breast cancer treatment and quality of life in Brazilian women

IntroductionPost-operative complications are a major cause of morbidity in women with breast cancer. The aim of this study was to evaluate the association between quality of life (QOL) before treatment...

Abstract P1-10-06: Racial Disparities in Physical and Functional Domains in Women with Early Breast Cancer

Abstract Background. There is limited research on the racial/ethnic disparities in breast cancer survivors’ (BCS) physical functioning and quality of life (QOL). Previous studies note that African American (AA) women are typically diagnosed with larger, more aggressive tumors and require more intensitve surgical and adjuvant treatment potentiating higher levels of functional morbidity. Reasons given for these disparities include; genetic predisposition, poor access to screening and cultural norms that may impact a patients willingness to seek screening and early treatment. This analysis compared the QOL and prevalence of physical impairments (including lymphedema, seroma, cording) of white and African-American BCS from a US Military hospital where all patients have coverage and access to health care services. Methods. Data was analyzed from 166 women (130 white and 28 African-American). Participants were assessed preoperatively and examined at 1, 3, 6, 9, 12-24 months post surgery for impairments by a physical therapist. QOL was assessed at 12-24 months post-operation through the Short Form Health Survey (SF36v2). Analysis of variance estimated differences in QOL and occurrences of impairments between white and African-American BCS. Results. African-American BCS: were premenopausal(P&amp;lt;.05), had ER/PR negative tumors(P&amp;lt;.001, P&amp;lt;.05), and received radiation(P&amp;lt;.05). No significant differences were found in type, stage, grade, or size of BC tumor, surgery type, lymph node dissection, or number of lymph nodes sampled. More AA BCS were employed(P&amp;lt;.05) and socially active(P&amp;lt;.05), but less recreationally active(P&amp;lt;.05); there were no significant differences in marital status. More AA BCS had axillary web syndrome(P &amp;lt;.05) and lymphedema(P &amp;lt;.05). No significant differences were found in seroma, fatigue, chestwall pain, shoulder pain, numbness, and self-reported QOL. Conclusions. Results suggest a difference in physical effects of BC treatment on white and AA women; however, contrary to other studies, no differences in QOL were noted. Our cohort demonstrates an interesting trend, in that only ER/PR status differed and other characteristics of the tumor were not different between racial groups. This differs from past reports and may suggest that access to care plays a role in promoting earlier stage diagnosis. However, despite the homogeneity of our cohorts tumor status we found that AA BCS may be at a higher risk for common impairments associated with BC treatment and should be monitored prospectively to mitigate the potential for impairments. Further research should examine effects of BC treatments on women of various ethnicities. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-10-06.

Axillary Web Syndrome or Cording, a Variant of Mondor Disease, Following Axillary Surgery

Axillary Web Syndrome or Cording, a Variant of Mondor Disease, Following Axillary Surgery

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.

Axillary web syndrome after axillary dissection in breast cancer: a prospective study

The axillary web syndrome is a self-limiting and frequently overlooked cause of significant morbidity in the early post-operative period after breast cancer axillary surgery, which is characterized by axillary pain that runs down the medial arm, limited shoulder range of motion affecting mainly shoulder abduction, and cords of subcutaneous tissue extending from axilla into the medial arm, made visible or palpable and painful by shoulder abduction. We evaluated the incidence of axillary web syndrome after axillary lymph-node dissection. Altogether 116 patients who underwent axillary lymph-node dissection were assessed for axillary web syndrome. Range of shoulder abduction, pain, and the subjective feeling of tightness along the arm were recorded. Axillary web syndrome was found in 56 patients, which means an incidence of 48.3% (CI95%: 38.9, 57.7). Axillary web syndrome is a significant self-limited cause of morbidity of axillary surgery ocurring not only in the early post-operative period.

Pre operative assessment enables the early detection and treatment of shoulder impairments related to breast cancer treatment.

Abstract Abstract #4091 Background: Early detection and management of impairments and limb dysfunction after breast cancer treatment contribute to more successful functional outcomes. Health care providers should be encouraged to provide a pre-operative screening visit to ascertain the patient's baseline physical function measures. Patients should then be followed prospectively at regular intervals during and after treatment for early identification of impairments and to provide intervention while the functional limitations are minimal, thereby preventing long term loss of function.&amp;#x2028; Materials and Methods: A prospective, observational study (n=196) with interval follow up over one year assessed the effects of an early identification and intervention model of physical therapy care on women after breast cancer treatment. Measurement of upper extremity (UE) function included; active range of motion (ROM), strength, and limb volume as measured by the optoelectronic volumeter (Perometer®), and self-reported physical activity disability. Individuals were seen for an initial visit prior to surgical treatment and followed-up at approximately one month post-operatively and at three month intervals thereafter, up to 18 months. Patients received a general home exercise program pre-operatively and instructed to initiate at 2 weeks post op. If impairments were identified at any of the follow up visits, physical therapy intervention was prescribed.&amp;#x2028; Results: A significant decrease in active shoulder ROM was noted at one month post-op as compared to baseline measurement in 102 patients. This significance resolved at the 12+ month follow up visit. Loss of shoulder ROM correlated with other UE treatment related morbidities including; axillary web syndrome, seroma and pain.&amp;#x2028; Discussion: Incidence of upper extremity morbidity after breast cancer treatment is documented as high as 70%. This study clearly demonstrates the potential for substantial reduction in UE dysfunction related to breast cancer treatment when using an early identification and intervention model. Many morbidities such as pain, reduced range of motion, decreased strength and sub-clinical lymphedema can be detected early and managed with minimal, cost-effective intervention. Additional research is needed to assess ways of maintaining this cost effective model of care in the long-term. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4091.

Axillary web syndrome

Axillary web syndrome is a not uncommon complication of axillary lymph node dissection. Consequently, it is surprising that the first in-depth review of this syndrome was published only a few years ago and that not a single article on this entity can be found in the Spanish language. Lack of awareness of this complication might lead to useless or contraindicated therapies being prescribed.We present the case of a patient with an axillary web of tissue and limited range of motion in the shoulder and provide a review of the literature.