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
Emine DÜNDAR AHİa, Selin OZENb, Sacide Nur SARAÇGİL COŞARb
aClinic of Physical Medicine and Rehabilitation, Private Medar Hospital, Kocaeli, TURKEY
bDepartment of Physical and Rehabilitation Medicine, Başkent University Faculty of Medicine, Ankara, TURKEY
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.
Anahtar Kelimeler: Aksiller web sendromu; lenfatik kording; omuz ağrısı; fiziksel tedavi
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.
Keywords: Axillary web syndrome; lymphatic cording; shoulder pain; physical therapy
REFERENCES
- Moskovitz AH, Anderson BO, Yeung RS, et al. Axillary web syndrome after axillary dissection. Am J Surg. 2001;181:434-9. [Crossref] [PubMed]
- 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]
- 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]
- Hunt WTN, Porter R, Lucke T. Axillary web syndrome induced by physical exertion. Clin Exp Dermatol. 2020;45:382-4. [Crossref] [PubMed]
- 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]
- Tetik B, Songür K, Aşkın A. [Axillary web syndrome: an overlooked cause of shoulder pain]. Cukurova Med J. 2019;44:255-9. [Crossref]
- 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]
- 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]
- 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]
- 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]
- Josenhans E. Physiotherapeutic treatment for axillary cord formation following breast cancer surgery. Pt Zeitschriftfür Physiother. 2007; 59:868-78. [Link]
- 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]
- 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]
- Rockson SG. Precipitating factors in lymphedema: myths and realities. Cancer. 1998;83:2814-6. [Crossref] [PubMed]
- Cheville AL, Tchou J. Barriers to rehabilitation following surgery for primary breast cancer. J Surg Oncol. 2007;95:409-18. [Crossref] [PubMed]