Axillary Web Syndrome (AWS), commonly known as “cording,” is a post-surgical complication involving a tight, painful band beneath the skin, typically in the armpit region. AWS is a recognized side effect of certain procedures. It restricts arm movement and causes discomfort, interfering with physical recovery. Early intervention is important for managing symptoms and restoring mobility.
Identifying Axillary Web Syndrome
AWS presents as a palpable, rope-like structure or web of tissue located just under the skin. This cord usually begins in the armpit (axilla) and can extend visibly down the inner arm, sometimes reaching the elbow, wrist, or thumb. In some cases, the cord may also run along the chest wall.
The physical sensation associated with cording includes tenderness, tightness, and a distinct pulling feeling when the arm is stretched. This tautness causes restricted mobility, making it difficult to lift the arm above the shoulder or fully extend the elbow. Symptoms can appear anywhere from a few days to several months following the operation.
Understanding the Causes and Risk Factors
Cording is most often a consequence of procedures involving the removal of lymph nodes, such as a sentinel lymph node biopsy or an axillary lymph node dissection. These surgeries, often performed for cancers like breast cancer, disrupt the network of vessels and connective tissue in the armpit. The resulting trauma causes inflammation, leading to scarring and fibrosis, or hardening, of the tissue.
The cords are believed to be made up of sclerosed (hardened) lymphatic vessels, veins, or surrounding fascial connective tissue. This fibrotic tissue adheres to nearby structures, creating the restrictive bands that limit arm movement. The extent of the surgery is a primary risk factor, with more extensive lymph node removal increasing the likelihood of developing AWS. Other factors that increase risk include a lower body mass index, younger age, and receiving radiation or chemotherapy.
Treatment and Therapeutic Management
Treatment focuses on releasing the restrictive fibrotic tissue and restoring a full range of motion to the arm and shoulder. Early and consistent intervention is recommended to prevent long-term restriction and stiffness. The standard approach involves referral to a specialist, such as a physical therapist or a certified lymphedema therapist, who guides the rehabilitation process.
Therapeutic modalities include gentle stretching and range-of-motion exercises designed to gradually tension the cord until the restriction releases. Therapists often employ techniques like manual lymphatic drainage or specialized massage to manually break up the scar tissue. Patients are also taught self-massage techniques involving firm, perpendicular pressure along the length of the cord.
Applying warm, moist heat can help ease pain and soften the tight scar tissue, making stretching and massage more effective. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to manage pain, particularly before therapeutic exercises. This focused management aims to restore flexibility and prevent the patient from instinctively limiting arm movement, which can worsen the condition.
Expected Recovery and Long-Term Outlook
Axillary Web Syndrome is generally considered a temporary condition that resolves with consistent therapeutic management. For most people, symptoms significantly improve or resolve completely within three to six months with appropriate therapy. Consistent application of stretching, massage, and therapeutic exercises is important for achieving a full recovery of arm and shoulder mobility.
While AWS was historically viewed as self-limiting, studies suggest the condition can persist for years in some cases. Even after initial symptoms subside, continuing a home exercise program is important to maintain flexibility and prevent the return of tightness. Although cording can recur, it typically does not become a persistent, long-term issue for most individuals.