Cording after surgery, also known as Axillary Web Syndrome (AWS), is a physical condition that can emerge following certain medical procedures, particularly those involving the armpit region. While its appearance can initially be concerning, cording is generally a manageable condition that improves with appropriate care.
Understanding Cording
Cording manifests as visible or palpable rope-like or string-like structures just beneath the skin, appearing as a single thick cord or multiple smaller strands. It typically occurs in the armpit, extending downwards along the inner arm, sometimes reaching the elbow, wrist, or hand. Cords might also be observed on the chest wall or torso.
Individuals often report tightness or pulling in the affected area, accompanied by sharp or shooting pain, especially when moving the arm. Cording can restrict arm movement and cause discomfort, impacting daily activities. Symptoms can appear days or weeks after surgery, though in some instances, they may not become apparent until months or even years later.
Causes and Risk Factors
The development of cording after surgery is primarily attributed to the disruption of lymphatic vessels, blood vessels, and surrounding connective tissues. Surgical trauma can lead to inflammation, causing injured tissues to harden and form fibrotic bands. While the exact mechanism is still being researched, this process involves the scarring and thickening of these delicate structures.
Cording is frequently associated with surgeries involving lymph node removal, particularly for breast cancer treatment. Procedures like mastectomy, lumpectomy, and especially axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB) are common precursors. The likelihood of developing cording increases with the extent of lymph node removal, with ALND generally carrying a higher risk than SLNB. Other factors that might elevate the risk include a younger age, a lower body mass index (BMI), and in some cases, complications during the healing process or prior radiation or chemotherapy treatments.
Treatment and Management
Addressing cording typically involves physical or occupational therapy. These therapies aim to restore normal arm function and alleviate discomfort. A therapist can guide individuals through specific techniques to manage the condition effectively.
Gentle stretching exercises are a foundational component of treatment, helping to improve flexibility and reduce tightness. Examples include arm raises, wall slides, and chest stretches, performed with a mild to moderate stretch held for 5 to 10 seconds. Nerve glides, also known as nerve mobilizations, can help address affected nerves and surrounding tissues by creating space and releasing binding that restricts motion.
Manual therapy techniques, often performed by a trained therapist, play a significant role in breaking down fibrous cords. These include manual lymphatic drainage (MLD), which uses gentle strokes to encourage fluid movement, and myofascial release, a technique targeting the connective tissue surrounding muscles and organs. Scar mobilizations and other soft tissue manipulations also help soften and release hardened tissue. For pain management, over-the-counter pain relievers like ibuprofen may be suggested, and cautious application of moist heat can sometimes provide relief, though excessive heat should be avoided as it might impact lymphatic fluid. Consistency with prescribed exercises and patience are important, as resolution can take time.
Recovery and When to Consult a Doctor
Cording is typically a temporary condition, often resolving within a few weeks to several months. While duration varies, it generally improves with conservative management and does not indicate a serious underlying complication. Most cases resolve without long-term side effects, and recurrence is uncommon. However, if left unaddressed, symptoms may persist and lead to ongoing movement restriction.
It is advisable to contact a surgeon or healthcare provider if certain signs or symptoms develop, including worsening pain or increasing restriction of arm movement despite ongoing therapy. While cording itself typically does not cause signs of infection, any new redness, warmth, pus, or fever should be promptly evaluated. Unexplained swelling in the arm should also be reported, as individuals who experience cording may have a higher risk of developing lymphedema. Seeking professional medical advice is important if the cording is not improving as expected or is significantly affecting daily activities and overall well-being. Early recognition and intervention often contribute to a more favorable outcome.