Axillary Web Syndrome (AWS) is a condition that can develop following medical procedures, particularly those involving lymph nodes in the armpit. This article explains what AWS entails, how it is identified, its causes, management, and recovery.
Understanding Axillary Web Syndrome
Axillary Web Syndrome, often called “cording,” involves the formation of fibrous tissue under the skin, resembling a tight string or cord. This condition arises as a side effect after surgery, especially when lymph nodes are removed from the armpit. The cords are felt as distinct, rope-like structures beneath the skin.
These cords typically appear in the armpit, extending down the inner arm, sometimes reaching the elbow, wrist, or hand. Cording may also be observed in the breast, chest, or abdominal region.
Recognizing the Signs
The defining characteristic of AWS is the presence of visible or palpable cord-like structures. These structures feel tight and rope-like, often becoming more noticeable with arm movements. Individuals may experience pain, tenderness, or a pulling sensation along the affected area.
This tightness and discomfort can restrict arm movement, particularly when raising the arm overhead or extending it fully. Daily activities like washing hair or reaching for objects can become challenging. Symptoms typically emerge days to weeks following surgery, though they can sometimes appear months later.
Causes and Risk Factors
AWS primarily develops after surgical procedures involving the axilla (armpit), such as lymph node dissection or sentinel lymph node biopsy. These procedures are frequently performed for breast cancer treatment. The exact mechanism behind AWS is not fully understood, but it is thought to involve inflammation, scarring, or damage to lymphatic vessels or veins.
This disruption can lead to the thickening of lymphatic vessels and the formation of fibrotic tissue, creating the characteristic cords. While most commonly linked to breast cancer surgeries, AWS can also occur after surgery to stage melanoma or when cancer causes swollen axillary lymph nodes.
Diagnosis and Management
Diagnosing AWS primarily involves a physical examination, where a healthcare provider can visually identify or palpate the characteristic cords under the skin. Imaging tests are not typically needed for diagnosis, but may be used to exclude other conditions with similar symptoms.
Management of AWS focuses on conservative treatments aimed at reducing pain and restoring range of motion. Physical therapy is a primary approach, incorporating specific stretching exercises like arm raises and wall slides to lengthen affected tissues. Manual lymphatic drainage, a gentle massage technique, can also alleviate symptoms. Pain can be managed with over-the-counter pain relievers or warm compresses.
Recovery and Outlook
The recovery timeline for AWS varies, but symptoms often resolve within a few weeks to several months with consistent treatment. This condition is generally temporary and not considered life-threatening. Most individuals achieve a full recovery of their arm’s range of motion and a significant reduction in pain.
While most cases resolve, symptoms may persist longer in rare instances. Continued physical therapy and adherence to recommended exercises can still provide ongoing benefits and improve comfort and mobility. Regular self-assessment for AWS is also recommended during the first few months post-surgery.