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Axillary web syndrome (AWS) is also called cording or lymphatic cording. It refers to the rope- or cord-like texture that develops just under the skin in the area under your arm. It may also extend partially down the arm. In very rare cases, it can extend all the way down to the wrist.
While the exact cause of cording isn’t understood, it may be that surgery in the underarm and breast areas damages the connective tissue surrounding the lymph vessels. This trauma leads scarring and hardening of the tissue, which results in these cords.
You can usually see and feel these rope- or cord-like areas under your arm. They can also feel like a web. They’re usually raised but in some cases may not be visible.
They’re often painful and restricting, causing a feeling of tightness when you try to raise your arm. You may find that you lose the normal range of motion in your arm, including when you try to straighten it.
These movement restrictions can make daily activities difficult.
AWS is usually a side effect that occurs after surgery to remove a sentinel lymph node or multiple lymph nodes from the area of your underarm. This procedure is most often done in relation to breast cancer treatment and surgeries.
AWS can also be caused by scar tissue from breast cancer surgery in the chest area without the removal of any lymph nodes. AWS may appear days, weeks, or months after your surgery.
In some cases, the cords will appear on your chest near where you’ve had a breast surgery, such as a lumpectomy.
You can manage the pain with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers if your doctor approves. However, anti-inflammatory drugs don’t seem to affect the cording itself.
Natural therapy methods
AWS is usually managed through physical therapy as well as massage therapy. You can try one type of therapy or use them in combination with each other.
Natural treatment for AWS includes:
- flexibility exercises
- range of motion exercises
- massage therapy
- lymphatic massage
- petrissage massage
While not a natural therapy option, laser therapy can be a beneficial treatment for AWS.
Applying moist heat directly to the areas of the cording may help, but ask your doctor before using any method with heat. Too much heat can stimulate lymph fluid production, which may increase cording and cause more discomfort.
While AWS isn’t completely preventable, it may help to do stretching, flexibility, and range of motion exercises before and immediately after any breast cancer surgery, especially when lymph nodes are removed.
The main risk factor for AWS is having breast cancer surgery that includes removing lymph nodes. While it doesn’t happen to everyone, AWS is still considered a fairly common side effect or occurrence after lymph node removal.
Other risk factors may include the following:
- being younger
- having a lower body mass index
- having complications during healing
With proper care and any exercises or other treatments recommended by your doctor, most cases of AWS will clear up. If you notice your arm feeling tight and you can’t raise it above your shoulder, or if you see the telltale cording or webbing in your underarm area, contact your doctor.
The symptoms of AWS may not appear until weeks or sometimes even months after the surgery. AWS is normally something that happens only once and doesn’t usually recur.