Cording (Axillary Web Syndrome)

What is cording?

Cording (axillary web syndrome) is a side effect of breast cancer surgery. It may happen when your surgical oncologist removes lymph nodes from your underarm (axilla or armpit). This procedure is called an armpit axillary lymph node dissection. They may do it to see if cancer in your breast has spread to those lymph nodes.

The condition gets its name from how it may affect you. If you have it, part of your underarm may look like there’s a cord or strand of wire pushing up under your skin. You may notice this when you stretch out your arm or raise it.

Axillary web syndrome isn’t dangerous. Having it doesn’t mean breast cancer returned (recurred). Cording symptoms often go away on their own. But cording can be painful and affect your ability to do daily activities. It can even keep your body from healing from breast cancer surgery. Physical therapy often eliminates the symptoms so you can focus on getting better.

How common is cording?

Experts estimate 5% to 32% of people who have breast cancer surgery develop cording.

What are the symptoms of axillary web syndrome?

Axillary web syndrome symptoms include:

• A sharp pain in your underarm if you stretch your arm out to raise it above your shoulder. (Think reaching for something on a high shelf or drying your hair or back after showering.)
• Your underarm or parts of your arm may feel tender to touch.
• The inside of your arm feels tight like your arm is swelling.
• Pain or stiffness in your shoulder.

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 can happen after an axillary lymph node dissection or sentinel node biopsy. In these procedures, surgical oncologists remove lymph nodes from the underarm that’s closest to the breast with cancer. They may do these procedures as part of other breast cancer surgery. For example, you may develop cording after you have a mastectomy or a lumpectomy when the lymph node surgery is done.

Those surgeries can damage lymphatic vessels in your underarm. They may also damage nearby connective tissue that surrounds those lymphatic vessels. Your damaged connective tissue may swell and harden into bands of scar tissue. Those bands or cords of scar tissue are what you see and feel if you have web cording.

What are the risk factors for axillary web syndrome?

Surgery to remove lymph nodes in your armpit is the main risk factor. Research suggests your weight and age may increase your risk. For example, studies show people with a low body mass index are more likely to develop cording. The condition typically affects people 55 and younger.

What are the complications of cording?

Most people recover from the condition after treatment. But without treatment, web cording may cause long-term pain, difficulty moving your arm or a frozen shoulder.

How do healthcare providers diagnose axillary web syndrome?

A healthcare provider will do a physical examination. They’ll take a close look at your underarm and where you have pain. They’ll ask when your symptoms started and if they’ve gotten worse. They may ask if specific tasks or activities make your symptoms more noticeable.

How is cording treated?

Cording treatment typically involves physical therapy. This treatment stretches the scar tissue cords so they naturally break apart and are absorbed into your body.

For example, you may need myofascial release therapy. Your physical therapist may recommend exercise that slowly increases your range of motion so you can move your arm without pain.

What can I expect if I have axillary web syndrome?

If you’re like most people, treatment helps stretch scar tissue cords, so it doesn’t hurt when you straighten your arm or lift it up to your shoulder. Everyone’s situation is a bit different. You may feel better after just a few therapy sessions. But sometimes, it takes several months before your symptoms go away.

How do I take care of myself?

The most important thing is to tell your provider about your experience so you can get help. Studies show some people think cording symptoms are part of the recovery process.

Cording is a breast cancer surgery side effect, but you don’t have to live with pain or frustration because shoulder pain keeps you from your daily activities. Treatment will help ease your symptoms. And there are things you can do on your own:

• Take it easy: Think of stretching the web cords the way you’d stretch your muscles to warm up for a workout. Your physical therapist will recommend exercises you can do on your own. They’ll explain how often you should do them.
• Try warm, moist heat: When you’re relaxing, put a warm, wet washcloth on the part of your arm that hurts or has cords. The warmth will help with pain and may soften tight scar tissue cords.
• Consider gentle activity: Once your oncologist says it’s OK to exercise, gentle activity like yoga can help stretch scar tissue cords. Ask your physical therapist about breast cancer rehabilitation programs that may include exercise.

When should I see my healthcare provider?

Cording symptoms can develop within weeks, months or even years after breast cancer surgery. Contact your healthcare provider if you notice changes like:

• Pain in your underarm.
• Difficulty stretching or raising your arm.
• Changes in the skin in your underarm or the inside of your arm.

Can you have cording without breast cancer?

You can, but it doesn’t happen very often. For example, one review of cording cases found just four times where something other than breast cancer surgery was the cause.