Dextrose Hydrodissection for Post-Breast Cancer Chest Wall and Axillary Tightness.

Inclusion Criteria: * History of breast cancer surgery (mastectomy or breast-conserving surgery), with or without axillary lymph node dissection * Persistent ipsilateral chest wall and/or axillary pain, tightness, or movement restriction lasting ≥ 3 months after surgery; * Clinically significant baseline symptom severity, defined as Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire ≥ 25 and/or pain intensity ≥ 5/10 on the Numeric Rating Scale (NRS); * Completion of 12 weeks of standard physical therapy with no significant improvement, defined as a change in QuickDASH score from baseline to completion of therapy below the minimal clinically important difference (MCID; \<15 points ) and/or pain improvement \< 2 points on the NRS . * Age ≥ 18 years; * Ability to provide written informed consent. Exclusion Criteria: * Evidence of local cancer recurrence or metastatic disease; * Active lymphedema requiring ongoing decongestive therapy at the time of enrollment; * Shoulder pathology, including intra-articular or peri-articular conditions (e.g., adhesive capsulitis with marked capsular restriction, or acute rotator cuff tear,) judged by clinical assessment to be the dominant cause of symptoms. * Active infection, skin lesion, or unhealed surgical wound at the intended injection site; * Known bleeding disorders or anticoagulant use contraindicating injection; * Known allergy to dextrose or any components of the injection protocol; * Pregnancy or other medi…