Cording is a common, though often alarming, side effect following breast cancer surgery, particularly procedures that involve removing lymph nodes from the armpit area. This condition is formally known as Axillary Web Syndrome (AWS). While the appearance of tight, rope-like structures can be concerning, AWS is a recognized and treatable surgical after-effect.
Defining Axillary Web Syndrome
Axillary Web Syndrome manifests as one or more tight, painful bands of tissue visible or palpable just beneath the skin, giving it the name “cording.” These cords typically originate in the axilla (armpit) and can extend down the inner side of the arm toward the elbow, wrist, or even the thumb.
The most significant symptom a patient experiences is a restriction in the range of motion of the affected arm. This tightness and stiffness become most pronounced when attempting to lift the arm overhead or extend the elbow fully. The cords themselves can feel tender, and movement often causes a sharp, shooting pain or intense pulling sensation in the armpit.
Cording can appear relatively soon after surgery, often within a few days or weeks, but it may also develop months or occasionally years later. This physical limitation can interfere with simple daily activities, such as getting dressed or reaching for objects, and may even complicate the positioning required for subsequent treatments like radiation therapy.
Underlying Causes and Risk Factors
The precise biological process that leads to Axillary Web Syndrome is not completely understood, but the accepted theory involves inflammation and trauma to the tissues in the underarm region. Surgical procedures that disrupt the delicate network of vessels and connective tissue, such as a mastectomy or lumpectomy, can trigger this inflammatory response.
The mechanism is thought to involve the formation of scar tissue (fibrosis) around the lymphatic vessels, and potentially superficial veins and nerves, near the surgical site. This scarring causes the affected vessels and connective tissue to harden, forming the palpable, restrictive cords. Research suggests the condition may also involve a localized clotting reaction within the lymphatic and venous channels.
The extent of lymph node removal is the primary factor determining the likelihood of developing AWS. Patients who undergo Axillary Lymph Node Dissection (ALND) have a higher incidence of cording compared to those who have only a Sentinel Lymph Node Biopsy (SLNB). Other factors that may increase risk include a lower body mass index, younger age, and the use of radiation therapy in the area.
Management and Therapeutic Interventions
Management of cording focuses primarily on conservative methods aimed at resolving the restrictive scar tissue and restoring full arm mobility. Physical therapy is the main intervention and should begin as soon as symptoms are noticed. Working with a therapist who specializes in oncology rehabilitation is highly beneficial for managing these specific post-operative complications.
The therapeutic approach involves a combination of manual techniques and active patient participation. Specific manual therapy techniques, such as soft tissue mobilization and myofascial release, are used to gently stretch and break up the tight, fibrotic bands. The therapist works to release the tension along the cord, often starting in the armpit and moving down the arm.
An exercise program is also prescribed, focusing on gentle stretching to increase the arm’s range of motion, particularly shoulder abduction and elbow extension. These targeted stretches are designed to lengthen the cords and prevent the muscle and joint capsule from tightening further. Supportive measures may include non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief, allowing the patient to participate more comfortably in the stretching exercises. The prognosis is generally favorable, with the condition often resolving completely over several weeks to a few months with consistent therapy.