Axillary web syndrome, also known as axial cording, can be a side effect of sentinel lymph node biopsy (SNB) or axillary node dissection (AND) – two types of surgery that involve removal of lymph nodes from the axilla (underarm). Both surgeries are used to help the oncologist decide on a treatment plan for those who have breast cancer.
Cording usually begins anywhere from a few days to several weeks after surgery. Cording may begin at the site of scarring in the underarm and can extend down the inner arm to the wrist and hand. Some symptoms of cording include pain occurring in the axilla and inner arm; and limited range of motion at the shoulder, elbow and wrist preventing overhead and reaching activities. You may see a cord like structure in your underarm area or just feel a “tightness” from your underarm to your wrist.
What makes this happen? During the surgery there may be trauma to the connective tissue in the axilla – an area that has many blood vessels, lymph vessels and nerves. This may lead to inflammation, scarring and hardening of the tissue in the axilla and down the inner arm. More research is needed to determine what the cords are made of and why cording happens. Studies report approximately 20% of women develop cording after SNB and 6-72% following AND.
It is important to begin rehabilitation as soon as you notice cording in your axilla. Physical and occupational therapists will use manual therapy to improve soft tissue mobility and to gently stretch the cords, along with exercises to increase your flexibility and strength. Patients are instructed in a home program to maintain gains made in therapy with the goal to resume previous activity levels.
This blog post was written by Cynthia Brennan, PT, CLT. Cynthia works at Milford Regional Medical Center Rehabilitation and Sports Medicine, 100 Commerce Drive, Northbridge, and specializes in the treatment of axillary web syndrome. For more information or to schedule an appointment with Cynthia, call (508) 234-8792. In addition, treatment for cording is also provided by clinicians at our Milford location at 42 Cape Road. For more information about our services in Milford, please call (508) 422-2388.