Introduction
lymphedema, upper limb disability, pain
LYMPHEDEMA, SYNDROME, COMPLICATIONS, AXILLARY WEB SYNDROME
Axillary web syndrome (AWS) is a condition experienced by many patients post-surgically, mainly after the mastectomy with axillary lymph node dissection (ALND) procedures. There are palpable cords in the axilla, and the surrounding tissues are suffered from pain and restricted joint motion of the affected side [AWS originates initially at the axilla and moves forward towards the medial arm, then the anteromedial forearm, and in severe cases, it involves the base of the thumb. Studies report that AWS is self-resolving and usually takes three months to resolve automatically, but some exceptions may persist further in some cases. Occurrence of AWS is generally reported within eight weeks post-surgically but can also appear over three months. The risk of developing AWS increases with age, ethnicity, prolonged surgery, low BMI, and complications in the healing process [AWS is often accompanied by restricted movement at the axilla, pain and lymphedema. Physical examination showed that the main characteristic of AWS is cording and webbing in superficial tissues of the axilla, chest, and arm, causing painful and restricted joint movement. The cord can be visible and easily palpable when the arm is fully extended and abducted [The effectiveness of physiotherapy in AWS management for upper limb disability, pain reduction and functional limitations is positively highlighted in the literature. It suggests early rehabilitation to avoid the aggravation of symptoms [Strength training is an essential part of approximately all rehabilitation programs for individuals of all ages to enhance strength [This study’s findings will develop awareness regarding the non-pharmacological management of patients with axillary web syndrome by improving their pain symptoms, shoulder mobility and quality of life. The results of this study can help formulate future guidelines for the management of AWS that help clinicians treat such patients more efficiently. The purpose of this study was to compare the effects of manual lymphatic drainage and soft tissue mobilization on pain threshold, shoulder mobility and quality of life in patients with axillary web syndrome.