Axillary Web Syndrome: Information and Management

A possible side effect of sentinel lymph node biopsy or axillary lymph node dissection is axillary web syndrome (AWS), or cording. Most patients with breast cancer are required to have at least one of these surgeries done, which eliminate either a few or many axillary lymph nodes. Patients who develop AWS often see or feel “a web of thick, ropelike structures” underneath the skin of the inner arm. The cording that occurs is often painful and tight. Patients may have difficulty lifting their arms higher than shoulder height and may not be able to fully extend the elbow, having a major impact on their everyday lives. While it is still not fully understood what causes cording, it is thought to have to do with trauma to the connective tissue that covers bunches of blood vessels, lymph vessels, and nerves in the chest and underarm area, leading to inflammation, scarring, and the eventual hardening of the tissue.

In working with a physical therapist, nurse practitioner, or physician associate who specializes in breast cancer rehabilitation, patients and providers can work together in developing a treatment plan that can help manage their AWS. Some management techniques may include stretching and flexibility exercises, manual therapy, moist heat, pain medication, or low-level laser therapy. Most people experience a resolution of cording after a few therapy sessions, but it may be useful for patients to continue with stretching exercises to help keep joint and soft tissue mobile during other treatments such as radiation and surgical recovery.


Axillary Web Syndrome (Cording). Updated July 27, 2022. Accessed October 21, 2022.

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