Breast Cancer and Axillary Web syndrome-what is it and how Physiotherapy might help.

By Rachel Sullivan

Axillary web syndrome (AWS) also commonly known as ‘cording’ is one of the common and cruel side effects of breast cancer related surgery. Here at In-Balance Physiotherapy, we know just how frustrating, disheartening and debilitating this condition can be. In this blog post we endeavour to explain what AWS is, common risk factors, early warning signs and what we can do to help you get back on track.

Why does Axillary Web Syndrome develop?

Surgery is the mainstay of primary breast cancer treatment. This surgery may involve a mastectomy (total removal of a breast), lumpectomy (abnormal lump removal) along with a sentinel node biopsy- which may include the removal of one or many axillary lymph nodes. Despite recent advancements in surgical approaches to breast cancer, post-operative symptoms such as this still remains a problem. Generally AWS occurs in the early post-operative phase, in many cases between 1-5 weeks post axillary node removal. 

The exact cause of AWS is still poorly understood in the literature, however, it has been suggested that the cords are lymphatic vessels that have become entrapped in scar tissue and become fibrotic forming a immobile, taut and in many cases painful cordlike structure.

Anyone who undergoes breast cancer surgery and removal of axillary lymph nodes may be at risk of developing AWS. 

Other risk factors that have been identified include:

Axillary scaring

Decreased or delayed shoulder mobility due to pain

Poor understanding of rehabilitation exercises

An overly vigorous approach to early rehabilitation

Excess post-operative swelling or infection

How do I know if I have developed Axillary Web Syndrome?

AWS is a distressing and debilitating condition for many breast cancer patients. Some of the symptoms you may experience include

pain in the armpit, which radiates down your arm to your forearm and hand. 

You will have restricted shoulder movement in particular lifting your arm up over your head or out to the side. 

Visible tight bands of tissue may also appear as you lift your arm. These tight bands can extend all the way to the wrist from your armpit and occasionally into the chest wall and ribs. 

axillary web syndrome

If you are at all unsure or concerned, ensure you see your physiotherapist for their expert assessment and advice.

Often, patients with restriction to shoulder movement only come to medical attention at the time of radiation simulation, when future cancer treatment may be delayed due to the inability to achieve and maintain 90 degrees of shoulder abduction with external rotation to allow for radiotherapy planning and treatment. 

So I think I have Axillary Web Syndrome, what should I do?

It is important to seek professional assessment and treatment from your physiotherapist as soon as possible should you become concerned you are developing AWS. Your physiotherapist will be able to apply a range of treatment techniques to assist with pain management and restoration of your shoulder range of motion and function. 

At In-Balance Physiotherapy these will include:

Education, encouragement and reassurance. We understand and can empathise with what you’re going through and we will empower you with the information you need to move confidently forward with your rehabilitation as an active participant with our full support. 

Myofascial soft tissue intervention and soft tissue stretching techniques have been shown to be effective to release tight cording and restoring upper limb function. 

Low level Laser therapy provides a minimal pain approach to allowing axillary cording to ‘soften’ and release, reducing pain and restoring functional shoulder range of motion. 

There are a number of Kinesio taping techniques to assist with treatment that your physio may also use. 

You will be provided with appropriate self-management strategies and stretches to continue to perform at home in between your physiotherapy sessions, this will help to maximise our outcome. 

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In summary, AWS is a common and often debilitating complication associated with breast cancer surgery. Here at In-Balance Physiotherapy we care and are passionate about assisting you through your cancer treatment and want you to recover with the best possible outcome. If you or someone you know currently or previously has had breast cancer, make an appointment to see Rachel Sullivan, our PINC & STEEL Cancer rehabilitation physio and Level 1 Lymphoedema Practitioner. We want you to SURVIVE TO THRIVE!