Following a mastectomy or related breast cancer surgery, a common post-operative side effect is the development of tight, rope-like structures under the skin. This condition, colloquially known as “cording,” is formally called Axillary Web Syndrome (AWS). AWS primarily impacts the arm and shoulder on the side of the operation.
Defining Axillary Web Syndrome
Axillary Web Syndrome is characterized by the presence of taut, fibrous cords just beneath the skin’s surface. These bands typically originate in the armpit (axilla) and can extend down the inner arm, sometimes reaching the elbow, wrist, or chest wall. AWS is common following surgeries involving lymph node removal, such as a sentinel lymph node biopsy or axillary lymph node dissection. The condition usually emerges days to weeks after the procedure, though onset can occur months later.
Understanding the Mechanism of Formation
The prevailing theory for AWS centers on trauma to connective tissues during surgery. Surgical disruption of the armpit area, particularly during lymph node removal, can injure small blood and lymphatic vessels. This injury leads to inflammation and sclerosis, which is the hardening of vessel walls and surrounding fascial tissue. The cords are thought to be thrombosed (clotted) lymphatic or venous vessels encased in fibrotic scar tissue.
Recognizable Symptoms and Impact on Mobility
AWS manifests primarily as a sensation of tightness and pulling, often accompanied by pain. Discomfort is felt especially when attempting to move the arm. The most limiting symptom is a restricted range of motion in the affected shoulder and arm. Activities requiring the arm to be raised above shoulder height or the elbow to be fully extended become difficult. This limitation can interfere significantly with everyday tasks like dressing, reaching, or preparing for necessary post-operative treatments such as radiation therapy.
Effective Management and Treatment Approaches
Management for Axillary Web Syndrome focuses on conservative treatment to restore full arm mobility and reduce discomfort. The most effective approach involves physical therapy (PT), often guided by a therapist specializing in post-mastectomy rehabilitation. PT aims to gently break down the fibrous cords and remodel the scar tissue.
Manual therapy is a cornerstone of this treatment, including specialized massage techniques like myofascial release and soft tissue mobilization to stretch and soften the cords. Stretching and flexibility exercises are also a major component, carefully progressing the patient’s range of motion. These exercises, sometimes referred to as nerve glides, help free restricted tissues and improve function. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended temporarily to manage pain during active stretching. With consistent treatment, the prognosis for AWS is very favorable; most cases resolve completely within a few weeks to a few months after starting physical therapy.