Axillary web syndrome (AWS), also known as cording can develop as a side affect of lymph nodes surgery such as sentinel node biopsy or axillary lymph node dissection. These types of surgeries are commonly performed in patients with breast cancer.

What causes AWS?

It is still unclear as to what causes axillary web syndrome however it is believed that the trauma from surgery against the connective tissues can cause inflammation and scar tissue to develop alongside the lymphatic vessels, blood vessels and nerves. This scarring can spread down the fibres of the connective causing "cords" to form.

It is also unclear as to how many breast cancer patients will develop axillary web syndrome. One study performed in 2012 showed an incidence of 28.1% following breast cancer surgery [1].

How Do You Manage Axillary Web Syndrome?

Patients who develop axillary web syndrome often complain of a "tightness" or "pulling" sensation in their armpit which can also travel up the arm to the wrist or down the chest wall. They often feel a web of strings or ropes under the skin of the arm and armpit particularly when attempting to raise the arm above shoulder height. These ropes or stings are commonly called "cords". In most cases, this tightness can also cause pain on stretching or when touching the cord. 

The pain or tightness experienced with cording has have a severe impact on function and movement. If you are planning on having radiotherapy after your surgery, it is important that you can raise your arm above your head comfortably.

If you develop symptoms of axillary web syndrome, it is important to seek help from a health professional experienced in breast cancer rehabilitation. For most people, axillary web syndrome with resolve after a few months, however your physiotherapist can show you important exercises and stretches that can quicken recovery as well as monitor for signs of lymphoedema.

3 things that may improve Axillary Web Syndrome

1. Stretches

Your therapist can teach you exercises to help stretch the cords to improve your upper limb range of motion

2. Manual Therapy

Your therapist may massage stubborn cords that are hard to stretch. Massage can sometimes cause the cord to break or snap. This is not usually painful and can lead to an immediate relief to symptoms and improvement in movement.

3. Low Level Laser Therapy

Some therapists may use a hand-held laser device to reduce pain and soften scar tissue.

It is important to commence arm and shoulder exercises following breast cancer surgery to gradually improve your range of motion and to help you get back to your usual activities.

For more information, read the Cancer Council's "Exercises after breast surgery" post which shows some simple arm exercises that you may start postoperatively. If you are unsure of what exercises you may perform, please talk to your doctor, breast care nurse  of physiotherapist.

If we can help you with any of your vertigo symptoms, please feel free to contact us:

Phone: 9553 8145
Website: www.eqphysio.com.au

Or if you're in the area, drop on by and have a chat with us to see if we can help in any way. We're located at 1/45 Montgomery St, Kogarah NSW 2217.

[1] Bergmann et al Breast Cancer Res Treat. 2012 Feb;131(3):987-92. doi: 10.1007/s10549-011-1805-7. Epub 2011 Oct 11.