The incidence of and risk factors for axillary web syndrome with limited shoulder movement after surgery for breast cancer, and the effect of early physical therapy intervention

Ya-Hui Chou; Su-Fen Liao; Dar-Ren Chen; Shou-Tung Chen; Wei-Te Wang

doi:10.1007/s12672-025-01740-y

The incidence of and risk factors for axillary web syndrome with limited shoulder movement after surgery for breast cancer, and the effect of early physical therapy intervention

Discov Oncol. 2025 Jan 4;16(1):7. doi: 10.1007/s12672-025-01740-y.

Authors

Ya-Hui Chou¹, Su-Fen Liao^{2

3

4}, Dar-Ren Chen^{5

6}, Shou-Tung Chen^{5

6}, Wei-Te Wang⁷

Affiliations

¹ Branch of Physical Therapy, Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan.
² Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 50006, Taiwan. [email protected].
³ Division of Pediatric Rehabilitation, Changhua Christian Children's Hospital, Changhua, Taiwan. [email protected].
⁴ Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan. [email protected].
⁵ Division of General Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
⁶ Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
⁷ Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 50006, Taiwan.

Abstract

Background: The aims of this cohort study were to identify (1) the incidence and risk factors for axillary web syndrome (AWS) with shoulder movement limitation within 4 weeks after axillary lymph node dissection (ALND) for Asian women with breast cancer (BC), and (2) whether early intervention with physical therapy (PT) could improve AWS, and how many PT sessions would be needed.

Methods: A cohort study of patients with BC receiving ALND was performed at Changhua Christian Hospital, Taiwan, between January 2019 and December 2020. Those patients who were diagnosed with AWS with shoulder movement limitation were referred to receive PT twice weekly at the Department of Physical Medicine and Rehabilitation.

Results: A total 173 BC patients receiving ALND were enrolled. The incidence of AWS with shoulder movement limitation was 18%, and the time to diagnosis was 26.3 days. In a subsequent multivariate analysis, younger age (OR = 0.95; 95% CI = 0.91-0.99; p = 0.019), higher number of removed lymph nodes (OR = 1.09; 95% CI = 1.03-1.16; p = 0.007) and receiving neoadjuvant chemotherapy (NAC) (OR = 2.96; 95% CI = 1.25-6.98; p = 0.013) were associated with an increased risk of developing AWS with shoulder movement limitation. The corresponding area under the curve was 0.762. Initial shoulder flexion and abduction were 132.1° and 123.4°, respectively. After 14.8 PT sessions, shoulder flexion and abduction improved to 172.3° and 171.8°, respectively. Improvement in shoulder range of motion was 40.2° and 48.4° in flexion and abduction, respectively, which was significant (p < 0.001).

Conclusions: In conclusion, we demonstrated a prediction model for AWS with shoulder movement limitation using 3 risk factors: younger age, a higher number of removed lymph nodes, and receiving NAC. Approximately 18% of BC survivors will have AWS with shoulder function limitation during the first month after ALND. An early intervention protocol with a PT program could effectively restore shoulder function.

Keywords: Axillary web syndrome; Breast cancer; Neoadjuvant chemotherapy; Physical therapy; Rehabilitation.