Abstract
Background: Axillary web syndrome (AWS) refers to cords presenting in the axilla, upper extremity, and lateral chest wall after breast cancer surgery with axillary lymph node dissection. This unique case demonstrates the onset of AWS 2 weeks post-operatively with recurrence at 4 and 21 months, following rapid progression in upper extremity strengthening exercise.
Case Description: A 33-year-old athletic woman with invasive ductal carcinoma underwent a left mastectomy with sentinel node biopsy (6 nodes removed). Cord development occurred at 2 weeks after surgery. She sought physiotherapy consisting of AWS education, myofascial pin-and-stretch techniques applied to the cord in end-range abduction, a home stretch program, and graduated strengthening. Resistance training recommenced 4 months after surgery and soon after, the cord reappeared. Left breast reconstruction occurred 15 months following initial surgery. 4 months later she increased her resistance training. Cording reappeared 2 months later.
Outcomes: Physiotherapy intervention assisted in cord resolution at each time point. After the last reappearance, the physiotherapist applied myofascial pin-and-stretch techniques to the lateral chest wall. It is uncertain at time of writing if this will allow for a more complete resolution of this woman’s AWS.
Discussion: Therapists should consider AWS education when treating patients diagnosed with breast cancer, especially in those at risk of developing AWS (younger women, women with low BMI, and athletic women). Exercise offers many benefits, but safe progression is an important education piece. The timing of this woman’s recurrent AWS seems to be linked to her increase in resistance training. This association would be an aspect worth investigating with further research.
First Page
26
Last Page
34
DOI
10.26890/gimh9247
Recommended Citation
Locke D, Koehler L. Recurring Axillary Web Syndrome (AWS) Following a Strenuous Increase in Upper Extremity Strengthening Exercise: A Case Report. Oncology Rehabilitation in Practice. 2026; 3(1):26-34. doi: 10.26890/gimh9247.