Axillary Web Syndrome (AWS) in Absence of Breast Cancer History or Surgery: A Case Report

Background: Axillary web syndrome (AWS) is a complication of breast cancer surgery with axillary lymph node removal. Cords are found within 2 weeks post-surgery in the axillary area of the operated side, and many extend down the arm or into the lateral chest wall. The purpose of this report is to present a unique case of idiopathic AWS, and to increase awareness of non-cancer related AWS in the medical community. Case Description: A 39-year-old healthy female presented to physiotherapy with a 2-week history of a palpable tight cord in her left axilla without history of cancer or surgery. She sought emergency medical care without a definitive diagnosis. She performed an internet search and found that AWS matched her symptoms and she scheduled a physiotherapy appointment. Assessment and Treatment: The physiotherapist confirmed that symptoms matched AWS, due to a visible axillary cord and loss of shoulder range. Treatment lasted 5-weeks, consisting of AWS education, myofascial pin-and-stretch techniques, home stretching, and graduated strengthening. At discharge, full range had been restored. A slight cord was palpable at this time, though function was no longer affected. Two weeks later the patient reported complete cord resolution. Discussion: This individual responded well to physiotherapy interventions commonly used in AWS presentations and has had no recurrence at time of writing. Idiopathic AWS is likely more common than what is observed in the literature. AWS is generally under-recognized and would benefit from communication and collaboration between health professionals so people may find timely diagnosis and care in future.