Axillary Webbing Syndrome (AWS) or sometimes referred as “Cording”, is characterised by a rope or cord like structure developed just under the skin under the arm. It is a painful condition affecting the normal movement of the shoulder, and in some cases extending to elbow and wrist.
The condition is developed in some people who have breast cancer following surgery to remove a few (sentinel) lymph nodes for biopsy, or many axillary (under armpit) lymph nodes (Axillary Lymph Node Dissection).
Causes for Axillary Webbing Syndrome (AWS)
The exact cause for the AWS is not known. Most AWS are diagnosed 2-8 weeks after breast cancer surgery. Some experts believe that surgery to the underarm and chest area can traumatise the connective tissues that surround nearby bundles of lymph vessels, blood vessels and nerves. An inflammatory response might trigger the connective tissues to form scars and become thickened.
In addition, sometimes after surgery to the chest area to remove the cancer, scar tissue will form and this may contribute to axillary webbing syndrome too.
Signs and symptoms
AWS presents as a tight, linear singular cord or multiple cords of tissues in the subcutaneous tissue under the armpit. The cords may further extend down to the inner side of the upper arm.
When the arm is elevated sideways with the elbow extended, the cord will become more visible and tight. At the onset of AWS, one will experience restricted arm movement, especially going up sideways. As the arm movement increases in range, pain and discomfort will increase.
Management of AWS
Pain killers such as non steroidal anti-inflammatory drug (NSAID) may help to alleviate some of the pain. It is important to stretch out the tight connective tissue to achieve a painless movement to maintain normal mobility of the arm.
Many studies have supported physiotherapy as a safe and effective primary treatment for AWS. Physiotherapy treatment include :
· Patient education
· Myofascial release
· Soft tissue mobilisation
· Cord manipulation
· Supervised home exercise program
· Extracorporeal Shockwave Therapy (ESWT)
ESWT can break down the adhesions of the tight connective tissues, reduce inflammation and decrease pain associated with AWS and can be an effective treatment adjunct to myofascial release and soft tissue mobilisation.
Our experienced physiotherapists can assist you to regain your shoulder/ elbow movement with less pain and earlier recovery of AWS.
Come and discuss about your concerns with us. Our experienced Physiotherapists Kevin Lau or Faith Hoffmann will give you support and help.