Refractory Axillary Web Syndrome Successfully Treated with Steroid Injections: A Case Report: Refractory Axillary Web Syndrome

Background: Axillary Web Syndrome (AWS) manifests after breast cancer surgery as 1mm wide, singular, or multiple cords that can extend from the ipsilateral axilla to the antecubital fossa and further into the forearm and wrist. These cords can be painful and cause diminished range of motion. Even though there is no current standard treatment for AWS, physical therapy is recommended as the first approach in management. In refractory cases, no management has been proposed. Case Presentation: We present a case of a 59-year-old female with right-sided breast pain and a palpable cord, refractory to one year of physical therapy, which began at the inframammary fold up towards the lumpectomy scar and further towards the axilla. Cord developed post-lumpectomy and post-radiation for a right-sided stage I invasive ductal carcinoma with negative sentinel lymph node biopsy. Based on the refractory nature of the cord, the patient underwent three treatments of steroid injections which made the cord less palpable and improved the pain. Due to persistent diminished range of motion and tenderness, the patient underwent a percutaneous needle cord disruption procedure with a last round of corticosteroid injection to prevent adherence of the cord pieces. At a 7-month follow up post-procedure, the breast cord was no longer present, and range of motion had been restored. Conclusion: We found that percutaneous cord disruption with concurrent steroid injections can be an effective treatment for AWS refractory to physical therapy.