Shoulder Kinematics of Axillary Web Syndrome in Women Treated for Breast Cancer

Published:October 03, 2022DOI:


      • Five years after surgery for breast cancer, women diagnosed with axillary web syndrome (AWS) have altered scapulohumeral kinematics that may place them at increased risk of shoulder pain and rotator cuff disease.
      • Women with AWS demonstrated less scapular upward rotation at 120° of arm elevation (P=.005), regardless of plane.
      • A better understanding of shoulder kinematics after breast cancer treatment could lead to specific and effective rehabilitation programs for cancer survivors with shoulder pain.



      To better understand how the shoulder moves in breast cancer survivors with axillary web syndrome (AWS), we compared 3-dimensional (3D) shoulder kinematics during shoulder elevation among breast cancer survivors with and without AWS 5 years postoperatively. Although research consistently shows decreased shoulder range of motion with AWS, we do not understand the underlying biomechanics.


      Nested case control study.


      University Academic Breast Center.


      Twenty-five women who had surgery 5 years previously for unilateral breast cancer with the removal of at least 1 lymph node participated in this study (N=25). Twelve participants had AWS; 13 women did not have AWS.


      Not applicable.

      Main Outcome Measures

      Three-dimensional shoulder kinematic data during shoulder forward flexion, scapular plane abduction, and coronal plane abduction were collected using 3D electromagnetic motion tracking. Kinematic data were extracted at 30°, 60°, 90°, and 120° of arm elevation for scapular upward rotation, internal rotation, and posterior tilt as well as for glenohumeral external rotation.


      Women with AWS demonstrated 15.2° less scapular upward rotation at 120° humerothoracic elevation (95% confidence interval [-25.2, -5.2], P=.005), regardless of plane. No significant between-group differences were found for any other angle of scapular upward rotation, nor for scapular internal rotation, scapular posterior tilt, or glenohumeral axial rotation at any angle.


      Five years after surgery for breast cancer, women diagnosed with AWS have altered scapulohumeral kinematics that may place them at an increased risk of shoulder pain based on existing kinematic literature in healthy cohorts. This information can help guide rehabilitation programs for breast cancer survivors to facilitate pain-free upper extremity function after treatment.


      List of abbreviations:

      AWS (axillary web syndrome), ROM (range of motion), 3D (3-dimensional), STur (scapulothoracic upward rotation)
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