What is axillary web syndrome?

Axillary web syndrome (AWS), also known as “cording”, is a condition that sometimes occurs after mastectomy or lymph node removal either by axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) for breast cancer diagnosis or treatment. After these procedures, tender cords of tissue can sometimes be felt under the skin. They usually begin at the armpit and run down the inside of the arm to the elbow, sometimes extending down to the thumb. Tender or sore to touch, they can make arm movements painful and reaching overhead or straightening your elbow can be difficult. AWS can appear one to eight weeks after surgery.

Causes of axillary web syndrome

More research is needed to understand the exact causes of AWS. It is believed that tiny veins and lymphatic vessels are damaged during surgery. This damage can cause inflammation and hardening of the connective tissue. There may be one distinct rope-like structure or several small cords under the skin. Some people do not feel the cords, but experience pain or a burning sensation along the inside of the arm. If arm movement is painful, it is common to avoid those positions that cause discomfort. However, refraining from movement can lead to more problems with mobility and function. It can be particularly problematic if cording occurs at the time of radiation therapy because the arm usually has to be in a raised position during this treatment.

Treating axillary web syndrome

Early therapy to address cording can be remarkably effective. Treatments such as soft tissue mobilization, myofascial release, nerve gliding, scar tissue release, laser therapy and other techniques can help break down the taut cords, restore movement, improve range of motion, and decrease pain. Breast Rehab therapists can also demonstrate exercises for you to stretch the area and provide education about posture help to decrease the symptoms. Early treatment for cording can be highly effective and, most of the time, the treatment can be completed within only three months!

If you notice the signs and symptoms of axillary web syndrome, a therapist at Breast Rehab can design a treatment plan that is right for you. Guided stretches and manual therapy can relieve the symptoms, prevent further complications, and help you regain shoulder mobility and function, allowing you to get back to doing what you love.