Bekir TETİK, Kadir SONGÜR, Ayhan AŞKIN

Aksiller web sendromu: omuz ağrısının gözden kaçan nedeni

Aksiller web sendromu (AWS), genellikle aksiller bölgeye yapılan girişim sonrası görülür. Fibrozis ile çevrelenmiş skleroze ven ve lenfatik dokular (kording) aksilladan başlayıp, kola ve ele kadar uzanabilir. Omuz eklem hareket açıklığını (EHA) kısıtlayan ve ağrıya sebep olabilen klinik bir durumdur. Paylaşacağımız olguda ise mevcut bir predispozan faktörün olmayışı dikkat çekicidir. İki hafta önce günlük aktivite sırasında sağ koltuk altında gerginlik ve ağrı hisseden 41 yaşında erkek hasta polikliniğimize başvurdu. Muayenesinde sağ aksiller bölgeden başlayıp sağ kol ortasına kadar uzanan gözle görülebilen düzeyde cilt altı kord görünümü mevcuttu. Sağ omuz hareketleri kısıtlı ve ağrılıydı. Hastaya oral non-steroidal antiinflamatuar ilaç (NSAİİ), elektroterapi programı ve omuz germe/güçlendirme egzersizleri reçete edildi. Hastanın 2 ay sonraki kontrol muayenesinde omuz EHA ağrısız, tam açıktı ve cilt altındaki kord bulgusu tamamen düzelmişti. Bilgimiz dahilinde olgumuz literatürdeki etiyolojisi bilinmeyen ikinci vakadır. Klinisyenlerin aksiller bölgede ve omuzda ağrı, omuz EHA’da kısıtlılık olan hastalarda AWS’i ayırıcı tanıda düşünmesi gerekmektedir. Bu hastalar uygun fizik tedavi modaliteleri ve NSAİİ’ın kombine kullanıldığı tedavilerden fayda görebilmektedir.

Axillary web syndrome: an overlooked cause of shoulder pain

Axillary web syndrome (AWS) is a clinical syndrome that usually seen after surgical intervention to axillary region. Fibrosis surrounded sclerotic vein and lymphatic tissue (cording), can extends from axilla to arm and hand. AWS can limit off shoulder range of motion (ROM) and can be the cause of shoulder pain. In the case we share, it is noteworthy that any predisposing factor does not exist. 41-year-old male patient was admitted our outpatient clinic with pain and feeling of tension on the right axilla which started 2 weeks ago during the daily activities. On the physical examination there was a subcutaneous cord that was visible from the right axillary region to the middle of the right arm. His right shoulder movements were limited and painful. The patient was prescribed oral nonsteroidal antiinflammatory drug (NSAID), electrotherapy program and shoulder stretching/strengthening exercises. After 2 months, on the re-examination, his right shoulder ROM was painless and in normal range; the subcutaneous cording had completely recovered. Within our knowledge, our case is the second case, whose etiology is unknown in the literature. Clinicians should consider AWS, in differential diagnosis in patients with axillary region/shoulder pain and shoulder ROM limitation. These patients may benefit from appropriate combination therapies that include physical therapy modalities and NSAIDs.

Keywords:

Axillary web syndrome pain, cording, physical therapy,

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