Understanding and Managing Axillary Web Syndrome
Dr. Berfin Mahmut
Axillary web syndrome (AWS), often called cording, is a common side effect of breast cancer treatment that affects up to 72% of survivors. It typically develops after axillary lymph node surgery but can also occur, though less frequently, following sentinel lymph node removal.
What Is Axillary Web Syndrome?
AWS is characterized by the formation of thin, visible, or palpable cords under the skin, which may extend from the armpit down the arm, sometimes reaching the inner elbow or thumb. These cords can feel like tight guitar strings or spider veins. In some cases, particularly for individuals with a lower body mass index, cording can also develop along the chest wall—referred to as truncal cording.
The condition can restrict shoulder movement, especially when lifting the arm out to the side, and if the cords extend to the elbow, it may cause tightness when straightening the elbow. AWS most often develops within a couple months after breast cancer surgery, but for some, it may appear later.
What Causes Cording?
The exact cause of AWS isn’t fully understood, but it is believed to be related to the body’s lymphatic and vascular systems’ response to surgery. The cords may be fibrous tissue or lymphatic vessels that have become tight or adhered.
Risk Factors for Cording
Several factors increase the likelihood of developing AWS:
- Type of Surgery: Mastectomy or axillary lymph node dissection procedures carry a higher risk compared to lumpectomy or sentinel lymph node biopsy.
- Number of Lymph Nodes Removed: The more lymph nodes removed, the greater the risk.
- Other Risk Factors: Younger age and lower BMI have also been associated with a higher likelihood of cording.
Is Cording Permanent?
The good news is that AWS is temporary for most people, and with the right interventions, many individuals see progress in just a few weeks. Although rare, cording can sometimes recur. Whether it’s your first experience or a recurrence, there are effective strategies to help you manage symptoms and regain your normal activities.
Physical Therapy: A Key to Recovery
Physical therapy can significantly reduce discomfort, improve range of motion, and break down restrictive cords. Physical therapists use soft tissue mobilization, myofascial release, and gentle stretching to loosen the cords. They can also prescribe targeted exercises that are simple and effective to maintain progress and improve flexibility over time. With regular practice and guidance from a physical therapist who has experience treating cording, survivors can regain mobility, reduce pain, and feel stronger.
Berfin Mahmut is a Doctor of Physical Therapy, a certified lymphedema therapist, and a cancer exercise specialist who specializes in cancer rehabilitation at Mount Sinai in New York, NY.
