Understanding Axillary Web Syndrome (aka Cording)

Understanding Axillary Web Syndrome: Causes, Presentation, and Treatment

Axillary Web Syndrome (AWS), also known as cording, is a common condition that occurs following breast cancer treatment. It is an under-recognised condition and is often assumed to be a normal part of the recovery process. However, it can make day to day activities more difficult as well as result in pain and tightness. Physio’s trained in breast cancer care can help provide guidance for you!

So what is Axillary Web Syndrome?

Axillary Web Syndrome (AWS) refers to the development of tight, rope-like cords of lymphatic tissue that extend from the axilla (aka arm pit), but can also present further down the arm into the elbow and hands. It is thought that these cord like structures are due to inflammation and scarring of the lymphatic vessels following trauma. They most often occur after breast cancer surgery and when lymph nodes are dissected in the arm pit.

Side note. If you’re wondering what lymphatic vessels actually mean. There are three main vessels within the body, arteries, veins and lymphatics. Arteries are responsible for taking blood to the tissues, veins are responsible for taking blood away from the tissues and lympathics are vessels help to remove excess fluid from the body and play a role in immunity (aka it can pick up on foreign invaders). Ok, back to AWS.

AWS can cause significant discomfort, pain and reduced range of motion, particularly when taking the shoulder out to the side. It can lead to reducing shoulder motion and limit participating in every day activities. And overtime can lead to long term shoulder pain and dysfunction. There is also the myth that these cords will resolve with time, however, some can remain for years if left untreated.

Who is Affected by Axillary Web Syndrome?

AWS most commonly affects individuals who have undergone treatment for breast cancer. Key risk factors include:

• Lymph Node Removal: People who have had axillary lymph nodes removed as part of breast cancer surgery are at a higher risk of AWS.

• Radiation Therapy: Radiation to the axilla may increase the likelihood of developing AWS.

• Younger Age: Research suggests that younger individuals undergoing breast cancer treatment are more prone to AWS.

• Low Body Mass Index (BMI): Leaner individuals may be at greater risk, possibly due to less protective tissue surrounding the lymphatic vessels.

• More extensive surgery

How and When Does AWS Present in the Clinic?

Cording typically develops one to nine weeks following surgery or radiation therapy. Common symptoms include:

• Palpable Cords: Visible or palpable tight cords under the skin, typically extending from the armpit down the arm.

• Pain and Tenderness: Discomfort, particularly when stretching the arm out to the side or engaging in overhead activities.

• Restricted Range of Motion: Difficulty lifting the arm above shoulder height or fully extending it. It can also present as difficulty fully extending the elbow and restricted hand movements.

• Tightness or Pulling Sensation: A feeling of tightness or pulling in the affected area during movement.

These symptoms can interfere with everyday tasks such as dressing, reaching, or carrying objects, emphasizing the importance of timely intervention.

Treatment Options for Axillary Web Syndrome

There is more evidence coming out about the role of physiotherapy in treating AWS, and most individuals experience improvement with the right interventions. Here are the main approaches:

1. Physiotherapy

Physiotherapy is the cornerstone of AWS management. A physiotherapist trained in oncology or lymphatic conditions can provide:

• Manual Therapy: Techniques such as myofascial release and gentle stretching to improve tissue mobility and reduce cord tightness.

• Range of Motion Exercises: Targeted exercises to restore mobility and function in the shoulder and arm.

• Progressive Stretching and Strengthening: Gradual stretching to lengthen the cords and alleviate discomfort.

2. Lymphedema Management

If AWS is accompanied by swelling, lymphedema management techniques like compression garments, manual lymphatic drainage, and decongestive therapy can be beneficial. At Kin, we aren’t trained lymphoedema specialists and would always recommend reviewing with a certified lymphoedma specialist for tailored support!

3. Pain Management

Pain relief strategies may include:

• Pain relief, as directed by your oncology team or GP.

• Cool packs for pain relief as needed

• Self release strategies as taught by your physiotherapist.

4. Education and Home Exercises

Your physio will provide you with stretches and strengthening program to help improve your shoulder range and function. You should know by now that physio’s love giving your home exercises so there isn’t a way from getting around this part unfortunately.

Conclusion

Axillary Web Syndrome is a manageable condition that can significantly impact an individual’s recovery and quality of life following breast cancer treatment. Early recognition and intervention, guided by a skilled physiotherapist, are crucial for optimal outcomes.

If you or someone you know is experiencing symptoms of cording/AWS, don’t hesitate to seek help from a healthcare professional specialising in oncology rehabilitation.

At Kin Physio, we are dedicated to supporting individuals through their breast cancer recovery journey. Contact us today to learn more about how we can help you overcome AWS and return to the activities you love.