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.

Cording after breast surgery

AWS is usually a side effect that occurs after surgery to remove lymph nodes from the area of your underarm. This procedure is most often done in relation to breast cancer treatment and surgeries. Axillary web syndrome can also be caused by scar tissue from breast cancer surgery in the chest area without the removal of any lymph nodes. AWS will usually appear days, weeks, or months after your surgery.

In some cases, the cords will appear on your chest near where you have had breast surgery, such as a lumpectomy.

While the cause of the formation of the webbing or cords is not certain, it is believed to be from the lymphatic fluid solidifying, or coagulating. This coagulation is usually due to the trauma that surgery causes to the area. The fluid that becomes solidified is what causes the cords or webbing.

Symptoms

You can usually see and feel these rope- or cord-like areas under your arm. They can also feel like webs. They are usually raised. However, in some cases they may not be visible. They are painful and restrict movement of your arm. They give your arm a tight feeling when you try to move it, especially when trying to raise it.

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

Axillary web syndrome treatment

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 do not seem to help lesson or affect the cording itself.

Therapy methods

Axillary web syndrome 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 and flexibility exercises, including range of motion exercises. Massage therapy has also proven helpful in managing AWS. Petrissage, which is a type of massage that involves kneading the area, seems to be the best type of massage for managing AWS. Petrissage is 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.

Home remedies

Applying moist heat directly to the areas of the cording may help, but this should only be done with caution and by a medical professional. Too much heat can cause the lymph production to increase, which may increase cording.

Risk factors of axillary web syndrome

The main risk factor for getting axillary web syndrome 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:

  • age
  • extent of the surgery
  • complications during healing
  • type of cancer

Prevention

While AWS is not completely preventable, it may be helpful to do stretching, flexibility, and range of motion exercises before and after any treatments that involve the lymph nodes or the areas near them. These exercises may be particularly helpful before and after any breast cancer surgery, especially when lymph nodes are removed.

Outlook

With proper care, exercises, and any other treatments recommended by your doctor, most cases of axillary web syndrome will clear up. You should always contact your doctor or oncologist if you notice your arm feeling tight and experience a loss in your ability to raise it above your shoulder.

If you see the telltale cords or rope-looking webs in your underarm area, you should let your doctor know. 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.