Dominic Stone
Cording, also known as axillary web syndrome (AWS), is a side effect of lymph node removal during breast cancer surgery. It involves the development of cord-like structures under the skin in the armpit or inner arm, causing tightness and pain that restrict arm movement. While the exact cause is unknown, cording is believed to arise from inflammation and scarring of the tissues surrounding lymph vessels, with a higher likelihood when more lymph nodes are removed. Treatment options include physical therapy, stretching, massage, and pain management, aiding recovery and preventing chronic pain.
| Characteristics | Values |
|---|---|
| Other names | Axillary web syndrome (AWS) |
| Cause | A side effect of breast cancer surgery to remove lymph nodes from the armpit (axilla) area |
| Appearance | A cord or web of cords that develop under the skin on the inside of the arm |
| Symptoms | Pain, tightness, and discomfort in the armpit and arm, difficulty raising the arm, reduced range of motion |
| Treatment | Physical therapy, stretching, massage, occupational therapy, home remedies (e.g., pain relievers, moist heat) |
| Prognosis | Symptoms usually resolve within a few therapy sessions or months, but can recur rarely |
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Cording symptoms
Cording, also known as axillary web syndrome (AWS), is a side effect of having lymph nodes removed as a result of breast cancer. It is characterised by the development of a cord or web of cords under the skin on the inside of the arm, which can extend partially down the arm and, in rare cases, all the way to the wrist. The symptoms of cording include:
- Pain and tightness in the armpit, especially when raising the arm above the head.
- Difficulty raising the arm or extending the elbow due to the tightness and pain caused by the cording. This can interfere with daily activities, especially if radiation therapy is required as part of the treatment plan.
- A cord-like texture that can be seen and felt under the skin in the underarm area. These cords may feel like a web and are usually raised, although they may not always be visible.
- Pain and stiffness in the shoulder, which can lead to a frozen shoulder if left untreated.
- The symptoms of cording may not appear immediately after surgery and can develop months or even years later.
While cording can be a concerning and uncomfortable experience, it is important to note that it is not a dangerous condition and does not indicate a recurrence of breast cancer. In most cases, symptoms can be effectively managed and resolved through physical therapy, stretching exercises, and massage therapy.
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Cording treatment
Cording, or axillary web syndrome (AWS), is a side effect of breast cancer surgery, specifically the removal of lymph nodes from the armpit area. The condition can cause pain and discomfort, and in some cases, can impact arm mobility. While there is no definitive cure for cording, various treatments can help manage the condition and alleviate symptoms. Here is a detailed guide on managing cording:
Stretching and Physical Therapy
One of the key treatments for cording is stretching. It is recommended to stretch the affected area twice a day for a few minutes each time. Hold each stretch for around 30 seconds and repeat it 5 to 10 times. A physical therapist can guide you through specific exercises to increase your range of motion and reduce pain. These exercises can be done at home, but it is important to follow the therapist's instructions on frequency and type of stretch. Swimming is another form of physical activity that can aid in regaining movement and reducing discomfort.
Massage and Manual Therapy
Massage therapy can help soften the cords and improve mobility. Manual treatments such as trigger point therapy, myofascial release, and scar tissue mobilization can also be beneficial. Gentle activities like yoga can also help stretch the scar tissue cords and improve flexibility.
Laser Therapy
Laser therapy is a non-natural therapy option that can be effective in treating AWS. A small device is used to send low-level laser beams to the cords, helping to break down the scar tissue.
Pain Management
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or other pain relievers can help manage pain associated with cording. While these medications do not treat AWS directly, they can provide relief from discomfort. Applying moist heat to the affected area may also help, but it is important to consult a doctor before using heat, as excessive heat can stimulate lymph fluid production and potentially worsen cording.
Occupational Therapy
Occupational therapy can help improve fine motor skills and increase independence in daily activities. An occupational therapist can provide specific exercises and guidance to aid in recovery.
It is important to remember that early treatment of cording can aid in recovery and prevent chronic pain. Consult a healthcare professional for guidance on the most appropriate treatment plan for your specific condition.
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Cording causes
Cording, or axillary web syndrome (AWS), is a side effect of breast cancer surgery. It is caused by the removal of lymph nodes from the armpit (axilla) area, which leads to the development of scar tissue. The more lymph nodes that are removed during surgery, the greater the chance of developing cording. However, it is important to note that cording can occur even with the removal of a single lymph node.
The exact cause of cording is not fully understood, but it is believed that the surgery damages the connective tissue surrounding the lymph vessels, leading to scarring and hardening of the tissue, resulting in the formation of cords. These cords can be felt and seen under the skin, causing a tight and painful sensation when trying to raise the arm. Cording typically occurs within a few days to weeks after surgery, but it can also develop months later.
While breast cancer surgery is the main cause of cording, it is important to note that AWS can also occur without the removal of lymph nodes. In some cases, AWS may appear on the chest near the site of breast surgery, such as a lumpectomy. The risk factors for developing cording include age and weight, with individuals having a lower body mass index being more susceptible.
Although cording is a common side effect of breast cancer surgery, it can often go undiagnosed and untreated. Early treatment of cording is important for recovery and preventing chronic pain. Treatment options include physical therapy, stretching, massage, and occupational therapy.
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Cording diagnosis
Cording, or axillary web syndrome (AWS), is a side effect of breast cancer surgery, specifically the removal of lymph nodes from the armpit area. It causes scar tissue to form, resulting in a rope-like texture under the skin that can be uncomfortable and restrict arm movement.
Diagnosis of cording typically involves identifying the characteristic symptoms, which include tightness and pain in the armpit and difficulty raising the arm. These symptoms usually develop within a few weeks of surgery, as the cord thickens and becomes more prominent. Patients may also notice visible cords under the skin, which can extend down the arm, sometimes as far as the wrist.
While cording is typically diagnosed based on symptoms and physical examination, imaging techniques may also be used to assess the extent and severity of the condition. Ultrasound, for instance, can help visualise the cords and determine the degree of thickening and tethering. This can aid in differentiating cording from other potential complications of surgery, such as lymphoedema or infection.
In some cases, a biopsy may be necessary to confirm the diagnosis and rule out other conditions. This involves taking a small sample of the affected tissue for laboratory analysis. This is particularly important if there are concerns about the recurrence of breast cancer, as AWS itself does not indicate a recurrence.
Once a diagnosis of cording is confirmed, treatment options can be considered.
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Cording prevention
Cording, or axillary web syndrome (AWS), is a side effect of lymph node removal as a result of breast cancer. It causes a web of cords to develop under the skin on the inside of the arm, which can be uncomfortable and restrict movement. While AWS isn't completely preventable, there are measures that can be taken to reduce the risk and severity of cording:
Pre-Surgery
Before surgery, it may be beneficial to do stretching, flexibility, and range-of-motion exercises. These exercises can help improve overall flexibility and mobility, which may reduce the risk of cording post-surgery.
Post-Surgery
After surgery, it is important to keep the affected area mobile. Gentle stretching exercises can help decrease pain and increase the range of motion. It is recommended to stretch twice a day for a few minutes, and to continue these exercises even after symptoms have disappeared.
Additionally, applying moist heat to the affected area may help, but it is important to consult a doctor before using any method that involves heat. While heat can provide relief, too much heat can stimulate lymph fluid production, which may worsen cording.
Physical Therapy
Physical therapy is highly effective in treating cording. A physical therapist can prescribe specific exercises to improve the range of motion and flexibility. They may also perform manual therapy techniques such as massage, which can help soften the cords and improve mobility.
Occupational Therapy
Occupational therapy can also be beneficial in improving fine motor skills and increasing independence with normal activities. An occupational therapist can provide specific exercises to help regain function and improve quality of life.
Medical Management
If approved by a doctor, over-the-counter pain relievers or anti-inflammatory drugs can be used to manage pain associated with cording. While these medications do not affect the cording itself, they can provide relief from discomfort.
In summary, while cording cannot be completely prevented, early diagnosis and intervention are key to reducing its impact. A combination of pre-and post-surgical exercises, physical therapy, occupational therapy, and medical management can help improve outcomes and reduce the severity of cording.
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Frequently asked questions
Cording, or axillary web syndrome (AWS), is a side effect of breast cancer surgery. It occurs when lymph nodes are removed from the armpit area to determine if cancer has spread. This results in the formation of cord-like structures under the skin, causing tightness and pain that restrict arm movement.
The first symptom of cording is usually pain or tightness in the armpit when raising the arm above the head. Over time, a cord or cords may become visible and palpable under the skin, extending from the armpit down the inner arm, sometimes as far as the wrist or chest.
Experts believe that cording is caused by inflammation and scarring of the tissues surrounding the lymph vessels, blood vessels, and nerves. It is more likely to occur when a larger number of lymph nodes are removed during surgery.
Treatment for cording includes physical therapy, stretching, massage, and occupational therapy. These interventions aim to improve range of motion, flexibility, and fine motor skills. Early treatment can aid in recovery and prevent chronic pain.
Cording is not uncommon, but it can go undiagnosed and untreated. It is important for patients and healthcare providers to recognize the symptoms of cording to facilitate prompt referral to physiotherapy and accelerate healing.
