Physiotherapy protocol to reduce the evolution time of axillary web syndrome in women post-breast cancer surgery: a randomized clinical trial

Abstract

Objective To reduce the evolution time of axillary web syndrome in women who have undergone breast cancer surgery.

Methods A prospective, randomized, single-blind clinical trial was conducted on 46 post breast cancer surgery patients from October 2021 to September 2024, in a single university hospital with painful Axillary Web Syndrome (AWS) that restricts arm mobility. The treatment for the intervention group consisted of stretching combined with manual therapy and scar massage to release adhesion and lymphatic cord during 15 physiotherapy sessions of 30 min duration each. The main outcome measures were: healing time, pain, evaluated with Visual Analogue Scaler (VAS) and arm Range of Motion (ROM), evaluated with goniometry.

Results Significant differences were detected in pain and in ROM. The effect of the intervention varied over time with 95% confidence interval (risk alpha 0.05) and a statistical power of 90% (risk beta 0.1). Comparisons between Control and Intervention Groups showed significant statistical and clinical differences in favour of Intervention Group after 30, 60 and 90 days of intervention at follow-ups for all measured parameters. The proportion of healed patients was significantly higher in the intervention group from day 30 onwards (two-sample test for equality of proportions: p < 0.001), indicating a faster recovery in the intervention group.

Conclusion The results suggested that stretching combined with scar massage and manipulative tissue release techniques lead to a faster recovery and reduce the evolution time of axillary web syndrome. The physiotherapy technique described in this article could be the technique of choice for this surgical sequela.

Trial Registration: ClinicalTrials.gov Registry (NCT05115799) on June 10th 2021 and the approval of the Andalucía Ethics Committee (PEIBA code 1909-N1-21, reg. number 171.21).