After surgery to remove lymph nodes in the armpit, some women develop cord-like structures under the skin on the inner arm. This is called cording or axillary web syndrome (AWS). We do not know exactly why cording happens. It is thought to be caused by inflammation and scarring of the tissues that surround the lymph vessels, blood vessels and nerves.
Cording is fairly common in women who have had most of the lymph nodes removed from the underarm. This is called an axillary lymph node dissection (ALND). It happens less to women who have had just 1 or 2 lymph nodes removed in a sentinel lymph node biopsy (SLNB).
You may be able to see or feel the cords when you lift your arm to shoulder height or above your head. There may be one thick cord or several smaller cords. They can cause a painful sensation and tightness that can reduce the range of movement of your arm and shoulder. This can affect your ability to do many daily activities.
Cording may develop within a few days of surgery, but it can develop a few weeks after surgery. Sometimes it appears many months later. This is called a late effect.
It is important to keep your arm and shoulder moving when you have cording. This helps prevent further tightness, which can cause more serious problems with movement.
The following tips may help:
- Ask your doctor to refer you to a physiotherapist. They can teach you exercises to gently stretch the cords and improve movement. Your specialist nurse may also be able to help you.
- Gentle massage to the area may help reduce pain and tightness. Your physiotherapist or specialist nurse may do this for you. They can also show you how to do it yourself.
- Apply a warm, moist heat pad. The physiotherapist may do this for you. It is important not to use it for too long each time, as heat can increase the risk of lymphoedema.
- If you have pain that stops you moving the arm and shoulder, ask your doctor for some painkillers. They may give you an anti-inflammatory painkiller, such as ibuprofen.
Cording usually gets better slowly over a few months. But it can last longer. Sometimes it can come back, but this is rare. If the cording continues, surgery can sometimes be done to improve symptoms.