What’s that cord in my arm?
What is Axillary Web Syndrome?
Axillary Web Syndrome, or cording, is a common side effect that occurs after breast surgery, specifically following a sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). In a SLNB, a few of your axillary or armpit lymph nodes are removed, whereas in an ALND, many of your axillary lymph nodes are removed. After such procedures, tender cords of tissue may develop and be seen underneath your skin, starting from your armpit.
Cording typically develops within 2-8 weeks following breast surgery. However, in some cases it may only develop months or even years later. Cording is reported in up to 86% of breast cancer patients.
What causes it?
The exact cause of cording is still not well understood. However, research suggests that it may be caused by damage to the connective tissue around lymphatic vessels, nerves and blood vessels. Damage from surgery and radiation therapy causes inflammation, scarring and hardening of the connective tissue around these vessels, which in turn causes the cords to form.
What are the signs & symptoms of cording?
Visible ropelike structures in your armpit, that may run down your inner arm and extend all the way to the base of your thumb. Cords may also run down the side of your chest.
A sensation of pulling and pain in your arm when reaching forward and overhead.
Difficulty lifting your arm beyond shoulder height or fully straightening your elbow.
Keep in mind that cording is not always visible. If you feel a tight pulling sensation in your arm during overhead movements, you most likely have Axillary Web Syndrome.
How is cording treated?
Cording can have a significant impact on your daily function, since it is often painful and limits your arm movement. Thus, if you have cording or suspect that you do, we recommend scheduling an appointment with a physiotherapist trained in cancer rehabilitation.
Under the guidance of a physiotherapist trained in breast cancer rehabilitation, your cording can be treated with a variety of techniques including:
Stretching exercises
Nerve gliding
Soft-tissue mobilization and myofascial release
Scar mobilization
Physiotherapy can help release your taut cords, improve your arm movement and reduce your pain. With physiotherapy and daily stretches, cording usually resolves within 3-6 months. Even after cording resolves, it is a good idea to continue to perform flexibility exercises in order to ensure that you retain your movement and flexibility, especially if you are still undergoing treatments such as radiation.
