Cording (Axillary Web Syndrome)

Cording (axillary web syndrome) is a side effect that you may experience after breast cancer surgery, especially if your surgeon removes your axillary lymph nodes. These are the lymph nodes in your armpit, close to your breast. You can develop a thick cord of scar tissue that runs through your underarm and down the inside of your arm. It can feel tight and painful, and it may prevent you from moving or using your arm.

Cording can develop weeks, months or even years after surgery. It may go away on its own — but you don’t have to wait for that. If it causes you pain or prevents you from doing your arm exercises after surgery, tell your healthcare provider. Movement is important to your recovery. It helps restore flexibility and prevent permanent stiffness. Physical therapy can help with cording so you can focus on healing.

Symptoms of axillary web syndrome (cording)

Cording symptoms may include:

• A feeling of tightness on the inside of your arm
• A visible cord running through your armpit or down your arm
• Sharp, shooting pains in your underarm when you stretch it out or raise it
• Shoulder pain or stiffness
• Tenderness in your arm or underarm

Cording symptoms don’t develop right away. In most cases, symptoms start about two weeks after your surgery. But your symptoms may not show up for months or even a few years later.

What causes cording?

Cording happens when surgery to remove lymph nodes in your armpit damages the dense web of lymph vessels and connective tissues there. The injured tissues form scar tissue that clumps together and restricts movement. You might have a standalone procedure to remove one or several lymph nodes and test them for cancer. This is part of cancer staging. Your surgeon might also remove lymph nodes during a lumpectomy or mastectomy.

Complications of cording (axillary web syndrome)

Axillary web syndrome isn’t particularly dangerous and may go away on its own. Treatment can help resolve it. But without treatment, symptoms may linger. The main thing to watch out for is if it prevents you from moving your arm. If you can’t move it enough after surgery, your tissues can tighten and contract. Some people may develop frozen shoulder.

How doctors diagnose axillary web syndrome

If you have symptoms of cording, tell your healthcare provider. They can diagnose it with a physical exam. They’ll take a close look at your underarm and the places where you feel pain. They might feel the tissue with their fingers or when they try gentle movements. They’ll ask about all of your symptoms, including:

• When they started
• When you notice them most
• If they’ve gotten better or worse

Don’t assume these symptoms are normal or necessary. Therapy can help.

How is cording treated?

Cording treatment typically involves physical therapy. During treatment, your physical therapist manually stretches and breaks up the scar tissue in your underarm. This allows your body to reabsorb the tissue. They might use various techniques. For example, some people might need myofascial release therapy. Your therapist might also give you exercises to practice at home. With practice, you’ll slowly improve your range of motion in your arm.

What’s the prognosis for axillary web syndrome?

Physical therapy usually helps relieve cording symptoms. How long this takes can vary from person to person. You may feel better after just a few therapy sessions. But sometimes, it can take several months to notice improvement. Try to be patient, gentle and consistent with your therapy. Your body is working hard to recover — not only from surgery, but also from cancer, and possibly other cancer treatments.

How can I take care of myself while recovering?

During your recovery, it may help to:

• Take it easy. Think of stretching the axillary web cords the way you’d stretch your muscles to warm up for a workout. Be intentional: pushing too hard, too fast will do more harm than good.
• Try moist heat. When you’re relaxing, try putting a warm, wet washcloth on the sore part of your arm. The warmth will help with pain and may soften tight scar tissue cords.
• Try gentle activity. Once your provider says it’s OK, gentle activity like yoga can help stretch out your tissues. There are also special physical rehabilitation programs for people who’ve had breast cancer.