ISSN: 1309 - 3843 E-ISSN: 1307 - 7384
FİZİKSEL TIP VE REHABİLİTASYON
BİLİMLERİ DERGİSİ
www.jpmrs.com
Kayıtlı İndexler


OLGU SUNUMLARI

İdiyopatik Aksiller Web Sendromu: Nadir Görülen Bir Hastalığın Olgu Sunumu
Idiopathic Axillary Web Syndrome: A Case Report on a Rare Entity
Received Date : 10 Mar 2021
Accepted Date : 17 May 2021
Available Online : 24 May 2021
Doi: 10.31609/jpmrs.2021-82996 - Makale Dili: EN
J PMR Sci. 2022;25(1):119-22
ÖZET
Aksiller web sendromu (AWS), aksiller bölgede ağ şeklinde fibrotik ven ve lenfatik dokular (kording) ile karakterize, omuz ağrısı ve eklem hareket açıklığında (EHA) azalmaya sebep olan bir patolojidir. İdiyopatik AWS hakkında olgu sunumları, literatürde az bulunmaktadır ve burada sunulan olgu, bilgimiz dâhilinde literatürdeki 3. olgudur. Yirmi dokuz yaşında erkek hasta, sol taraflı omuz ağrısı ve EHA’da azalmaya eşlik eden aksiller bölgede şerit şeklinde uzanan “kord” belirtisiyle kliniğimize başvurdu. Diagnostik ultrason ve manyetik rezonans görüntülemeleriyle idiyopatik AWS tanısı konuldu. Omuz, kol EHA ve progresif dirençli egzersizi, omuz fleksörlerine ve abdüktörlerine germe egzersizi ve kord miyofasiyal gevşetme tedavileri uygulandı. Fiziksel modalitelerinden infrared, terapötik ultrason ve transkutanöz elektriksel sinir stimülasyonu uygulandı. Tedavi sonucunda, hastanın omuz ağrısı ve aksillerdeki kordlar geriledi, omuz EHA arttı. Omuz ağrısı ve azalmış EHA ile başvuran hastada, AWS tanısı düşünülmelidir ve detaylı omuz muayenesi yapılmalıdır. AWS’nin 1. basamak tedavisi henüz belirlenmemiştir. Belirlenmesi, erken tedavi ve böylece kronik omuz disabilitesi gelişmesini önleyecektir.
ABSTRACT
Axillary web syndrome (AWS) is characterized by a web of fibrotic vein and lymphatic tissue cords in the axillar, shoulder pain and reduced range of motion (ROM). Cases of idiopathic AWS have rarely been reported in the literature; to the best of our knowledge, the case described here is the third. A 29 year old male presented with left sided shoulder pain and reduced ROM and cords in the axilla. A diagnosis of idiopathic AWS was made using diagnostic ultrasound and magnetic resonance imaging and treated using shoulder and arm ROM and strengthening exercises, stretching of shoulder flexors and abductors and cord myofascial release. Physical modalities included infrared, therapeutic ultrasound and transcutaneous electrical nerve stimulation. The patient’s shoulder pain, reduced ROM and cords resolved with treatment. A diagnosis of AWS should be considered in patients with shoulder pain and reduced ROM, a detailed shoulder examination is essential. The first line treatment for AWS is yet to be determined; this will ensure its timely management and so avoid the development of chronic shoulder disability.
REFERENCES
  1. Moskovitz AH, Anderson BO, Yeung RS, et al. Axillary web syndrome after axillary dissection. Am J Surg. 2001;181:434-9. [Crossref]  [PubMed] 
  2. Koehler LA, Hunter DW, Blaes AH, et al. Function, shoulder motion, pain, and lymphedema in breast cancer with and without axillary web syndrome: an 18-month follow-up. Phys Ther. 2018;98:518-27. [Crossref]  [PubMed]  [PMC] 
  3. Welsh P, Gryfe D. Atypical presentation of axillary web syndrome (AWS) in a male squash player: a case report. J Can Chiropr Assoc. 2016;60:294-8. [PubMed]  [PMC] 
  4. Hunt WTN, Porter R, Lucke T. Axillary web syndrome induced by physical exertion. Clin Exp Dermatol. 2020;45:382-4. [Crossref]  [PubMed] 
  5. Demir Y, Güzelküçük Ü, Kesikburun S, et al. A rare cause of shoulder pain: axillary web syndrome. Turk J Phys Med Rehabil. 2018; 63:178-80. [Crossref]  [PubMed]  [PMC] 
  6. Tetik B, Songür K, Aşkın A. [Axillary web syndrome: an overlooked cause of shoulder pain]. Cukurova Med J. 2019;44:255-9. [Crossref] 
  7. Beaton DE, Katz JN, Fossel AH, et al. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14:128-46. [Crossref]  [PubMed] 
  8. Leidenius M, Leppänen E, Krogerus L, et al. Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg. 2003;185:127-30. [Crossref]  [PubMed] 
  9. 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;47:164-76. [PubMed] 
  10. O'Toole J, Hannon K, Skolny MN, et al. The role of sonographic imaging to assess the pathophysiology of cording in patients treated for breast cancer: a pilot study. J Diagn Med Sonogr. 2015;31:276-81. [Crossref] 
  11. Josenhans E. Physiotherapeutic treatment for axillary cord formation following breast cancer surgery. Pt Zeitschriftfür Physiother. 2007; 59:868-78. [Link] 
  12. Fourie WJ, Robb KA. Physiotherapy management of axillary web syndrome following breast cancer treatment: discussing the use of soft tissue techniques. Physiotherapy. 2009; 95:314-20. [Crossref]  [PubMed] 
  13. Miller DL, Smith NB, Bailey MR, et al; Bioeffects Committee of the American Institute of Ultrasound in Medicine. Overview of therapeutic ultrasound applications and safety considerations. J Ultrasound Med. 2012;31: 623-34. [Crossref]  [PubMed]  [PMC] 
  14. Rockson SG. Precipitating factors in lymphedema: myths and realities. Cancer. 1998;83:2814-6. [Crossref]  [PubMed] 
  15. Cheville AL, Tchou J. Barriers to rehabilitation following surgery for primary breast cancer. J Surg Oncol. 2007;95:409-18. [Crossref]  [PubMed]