Axillary web syndrome

Axillary web syndrome (AWS) is also called cording or lymphatic cording. It refers to the rope- or cord-like areas that develop 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 your wrist.

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 have had a breast surgery, such as a lumpectomy.

While the exact cause of cording isn’t understood, it may be that surgery in these 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 be like a web. They’re usually raised, but in some cases may not be visible. They’re painful and restrict arm movement. They cause a tight feeling, especially when trying to raise your arm.

The loss of range of motion in the affected arm may keep you from being able to raise your arm to or above your shoulder. You may not be able to straighten your arm fully because the elbow area may be restricted. These movement restrictions can make daily activities difficult.

Over-the-counter options

You can manage the pain with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers if your doctor approves. Anti-inflammatory drugs, unfortunately, don’t seem to help lessen or affect the cording itself.

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.

Therapy for AWS includes stretching, flexibility, and range of motion exercises. Massage therapy, including lymphatic massage, has also proven helpful in managing AWS.

Petrissage, a type of massage that involves kneading, seems to be the best for managing AWS. It’s not painful when done correctly.

Another option your therapist may suggest is laser therapy. This therapy uses a low-level laser to break up the scar tissue that has hardened.

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.

The main risk factor for AWS is having breast cancer surgery that includes removing lymph nodes. While it does not 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:

  • younger age
  • lower body mass index
  • extent of the surgery
  • complications during healing

While AWS is not completely preventable, it may help to do stretching, flexibility, and range of motion exercises before and after any breast cancer surgery, especially when lymph nodes are removed.

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 can’t raise it above your shoulder, or 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 does not usually reoccur.

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