Joachim Zuther, Lymphedema Specialist.
A number of patients who underwent axillary lymph node dissection (ALND) in combination with breast cancer surgery experience postoperative pain and limited range of motion associated with a palpable cord of tissue extending from the axilla into the arm on the same side.
This condition is known as Axillary Web Syndrome (AWS), or Cording Syndrome is little known in the medical field, and I am happy to publish an article on this condition written by a long-time friend and colleague, Linda Koehler. Linda is an expert in this field and also covered this topic extensively in the latest edition of my textbook “Lymphedema Management”. I am very proud to have Linda contribute as she is also one of my previous students.
Axillary Web Syndrome (i.e. ‘cording’)
By: Linda Koehler, PT, CLT-LANA, PhD
Description and Symptoms
Axillary web syndrome (AWS) is a condition which appears following cancer surgery with axillary lymph node removal (i.e. breast cancer or melanoma).1,2 AWS usually occurs within 2-4 weeks following surgery though it has also been identified in patients months to years after surgery.3-5 The incidence of AWS ranges from 6-72%.1,3 AWS appears as a 
cord of tissue just underneath the skin located in the axilla (i.e. armpit) and may run down the inside of the arm towards the elbow. It sometimes extends down as far as the hand near the thumb and also has been indentified along the side of the trunk underneath the arm. Restrictions in movement and pain often accompany this condition. The cord becomes tight with movement of the arm especially with shoulder abduction (bringing the arm out to the side). If the cord runs down the arm, elbow extension (straightening the elbow) and wrist movements can also be limited in addition to restricted movements of the trunk.
A person with AWS tends to experience pain and pulling sensation with movement of the arm especially shoulder abduction because this movement puts tension on the cord. There is usually little to no pain when the arm is at rest. It is common for a person to have good movement in the arm following surgery but then movement becomes limited and painful when the AWS cord begins to develop. The sudden onset of pain and limited movement may lead to anxiety and stress in someone who is already dealing with a cancer diagnosis. AWS appears to occur more often in people who are slimmer for reasons unknown.1,3 It is speculated the cord is easier to identify in a person with a slim build because there is less fatty tissue to conceal the cord. It is possible AWS is present in obese patients, but the cord is not detectable because it is covered by fatty tissue. Another theory is the cord may not be able to adhere to fatty tissue therefore is less likely to occur in patients who are heavier set.
Physiology
The cause of AWS is still unknown but appears to be associated with lymph node removal therefore having a possible lymphatic involvement. The literature reports there is a higher incidence of AWS and a more extensive AWS cord with a higher number of lymph nodes removed.1 The AWS cord appears to extend further down the arm in patients with more lymph nodes removed. It is speculated the cord is caused by a blockage in a vessel, lymphatic or venous, or by tightness in the surrounding tissue.1,3 Biopsies of the cord have identified it as being a vessel, both lymphatic and venous, with more evidence suggesting lymphatic vessel involvement.1,5,6 More research is needed to identify the underlying cause and physiology of AWS.
Therapeutic Approach
Here is a good video with instructions on stretches and other exercises to helb alleviate cording.
Some people believe AWS completely resolves on its own within about three months after surgery therefore treatment is not necessary.1 Others believe the cord may not completely go away which may lead to long term movement restrictions and functional problems.5,7,8 It appears treatment to the AWS cord may improve movement and reduce pain sooner than no treatment.4,5,9
Pain medications such as non-steroidal anti-inflammatory drugs (NSAIDS) may be recommended dependent on the amount of associated pain.10 Since pain is often experienced with certain movements, some patients will avoid moving the arm. Lack of movement could lead to other problems such as soft tissue tightness and joint problems therefore avoiding movement is not recommended. Movement of the arm is encouraged but minimal to no pain should be experienced during the movement.
Rehabilitation treatment such as physical therapy has been used to treat the movement restrictions caused by the cord.4,5,7,9,11-13 The techniques include gentle stretching of the cord and surrounding muscles and soft tissue to improve movement. Manual techniques have been described as skin traction, cord bending, myofascial release, soft tissue mobilization, and scar releases. Gentle manual techniques are recommended to avoid lymphedema or reddening of the skin. At times, the cord has been reported to break with manual techniques which results in an immediate increase in movement. The breaking of the cord may be felt and heard by the patient and/or therapist. It is unknown what is actually breaking but it is speculated it could be the cord or the supporting tissue around the cord. It doesn’t appear there are any negative effects from breaking the cord since the patient sustains the sudden gain in movement. It is highly recommended therapists should be cautious when using manual techniques and avoid being too aggressive. Breaking of the cord is mentioned only to inform patients and medical professionals about the possibility of the cord breaking with gentle manual techniques. It is not recommended aggressive treatment techniques be used to purposively break the cord.
Further research is needed to fully understand the phenomenon of AWS, the physiology, and treatment.
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References:
1. Moskovitz AH, Anderson BO, Yeung RS, Byrd DR, Lawton TJ, Moe RE. Axillary web syndrome after axillary dissection. Am J Surg. 2001;181(5):434-439.
2. Severeid K, Simpson J, Templeton B, York R, Hummel-Berry K, Leiserowitz A. Lymphatic cording among patients with breast cancer of melanoma referred to physical therapy. Rehabilitation Oncology. 2007;25(4):8-13.
3. Leidenius M, Leppanen E, Krogerus L, von Smitten K. Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer. Am J Surg. 2003;185(2):127-130.
4. Koehler LA. Axillary web syndrome and lymphedema, a new perspective. Lymph Link. 18(3): 9-10; 2006.
5. Josenhans E. Physiotherapeutic treatment for axillary cord formation following breast cancer surgery. Pt_Zeitschrift für Physiotherapeuten. 2007;59(9):868 – 878.
6. Reedijk M, Boerner S, Ghazarian D, McCready D. A case of axillary web syndrome with subcutaneous nodules following axillary surgery. Breast. 2006;15(3):411-413.
7. Kepics JM. Physical therapy treatment of axillary web syndrome. Rehabil Oncol. 2004;22(1):21-22.
8. Koehler LA. Treatment considerations for axillary web syndrome. Proceedings of the Seventh National Lymphedema Network International Conference, Nashville, TN; 25; November 2006.
9. Wyrick SL, Waltke LJ, Ng AV. Physical therapy may promote resolution of lymphatic cording in breast cancer survivors. Rehabilitation Oncology. 2006;24(1):29-34.
10. Cheville AL, Tchou J. Barriers to rehabilitation following surgery for primary breast cancer. J Surg Oncol. 2007;95(5):409-418.
11. Fourie WJ, Robb KA. Physiotherapy management of axillary web syndrome following breast cancer treatment: discussing the use of soft tissue techniques. Physiotherapy. 2009;95(4):314-320.
12. Torres Lacomba M, Mayoral Del Moral O, Coperias Zazo JL, Yuste Sanchez MJ, Ferrandez JC, Zapico Goni A. Axillary web syndrome after axillary dissection in breast cancer: a prospective study. Breast Cancer Res Treat. 2009;117(3):625-630.
13. Koehler LA. Axillary Web Syndrome. In: Zuther, JE. Lymphedema Management, The Comprehensive Guide for Patients and Practitioners. 2nd ed. New York, NY: Thieme Medical Scientific Publishers; 2009:70-72.
Thank you for an informative article.
I am a 42 yr old mail who had a large area of my right axilla and pectoral muscle removed after chemo leaked from my port in to my brachial plexus region. I have also receieved radiation in this area, causing lymphedema. I have several “cord type” areas along my armpit/arm area. I find that stretching is a good way to release pain however, once the area tightens back up, the pain is sometimes worse. Does this mean I should just do more stretching? Thanks for the article!
Dear Matt:
Thank you for your comment. More stretching may be appropriate; however, you should definitely consult with a therapist familiar with this condition.
Can this happen to the leg after nodes have been removed from the groin area during uterine cancer surgery?
Dear Ann,
I haven’t personally seen cording in the leg but have talked to therapists who have described a similar phenomenon of cording in this ares so I think it could be possible. As Jane Kepic’s comment mentions, it may be related to Mondor’s disease and there is literature that describes Mondor’s disease in the groin region (i.e. penile Mondor’s disease). I have observed cords in the neck region before so I think it is possible it could happen in other areas.
Jane Kepics, Jodi Winicour, and Elisabeth Josenhans (mentioned in other comments) have been a wonderful asset in bringing attention to this often ignored condition. Kudos to them all!!
I have never seen this in the legs
Nor have I seen anything in The literature about it. They think it may be’ related to’ Mondor’s syndrome which is a local phlebitis of The breast so I doubt it will occur in The legs.
We have a page on our site devoted to axillary web syndrome. Jodi Winicour has recommended that patients limit the stretch on their axilla in the first 10-14 days post axillary surgery to allow maximal lymphatic reconnection and healing to occur. We do have videos of manipulation from Elisabeth Josenhans PT that are available to qualified therapists to review.
http://www.stepup-speakout.org/Cording_and_Axillary_Web_Syndrome.htm
The few articles in the medical literature stated that cording did not increase risk of lymphedema, yet the International Best Practices Guidelines identify AWS as a risk factor for lymphedema, along with axillary seroma (which often seems to be present in cases of extensive webbing.)
Thanks for bringing more attention to this common and frequently overlooked condition.
Great article. I have seen many patients with this and all have improved with soft tissue work- some within 1-2 sessions and others up to around 8. I have experienced the “popping” on 3 occasions and it was loud, did not hurt the patient, and they immediately had a significant improvement in abduction. Scar massage is so necessary. I have had great success using the “snakebite kit” -sold under scar care in therapy catalogs- on adhered breast scars, drains sites,total knee scars- anywhere a scar needs suction to be lifted to break adhesions.
I have seen it along the trunk as well (more rare) but have never seen it in the leg.
Good article. I’ve got lymphedema in both legs (surgery/radiation) – one stage 1, one stage 2. Onset a couple years post-treatment.
I had something that sounds very similar to this in my stage 1 leg about 5 weeks after treatment ended. I experienced a lot of pain and couldn’t walk correctly. A wonderful physical therapist did about 6 weeks of soft tissue work and helped me learn to ‘walk’ again. That side is stiff compared to my other side.
I wish that lymphedema research was conducted more frequently on both arm and leg lymphedema. The lack of data on lower extremity lymphedema makes diagnosis, treatment and (almost most important) reimbursement challenging.
Thank you for doing your blog!
Great article. I have seen many patients with AWS and find the slow, myofacial release helps to release the tightness without the ‘Pop’. What do you use as ICD 9 code for this condition????
A patient is being referred to us who seems to have cording in the chest wall (described by the PA as along the clavicular line). Has anyone ever seen or treated this?
Dear Wendy – cording may extend to the chest wall.
We have a patient that we are treating physical therapy for AWS. What do you use as ICD 9 code for this? Thank you for your help.
I’d suggest to use the manual mobilization code
My pain and cording began 1 1/2 weeks ago, and is described well by this article. However, I am male and have been in good health, other than the need for more exercise. The pain began out of the blue with no apparent trigger. I will go see my doctor this week, but I would be grateful to know if you have seen this scenario before and how it occurred. Thanks for this article Linda and Joachim.
Jared, just wondering what the outcome was of your armpit cord? i am 41 and just discovered this a week ago on my left side. i thought it was from working out, but my doc is sending me to see a vascular surgeon.
Larry can you tell me your out me please, I am a 38 male and this type of thing has appeared under my left armpit and haven’t been to the doctors yet , I’ve had it for around 2 weeks now
Sorry outcome
you got facebook?
http://www.facebook.com/LymphedemaGuru
Is there any other treatment other than PT? I have had this cord , began PT 4 weeks after surgery as physian and myself had no idea what was going on! It did help some but now is back 4 months later. I have started PT again but am just doing my research to figure my options since my Dr. act like he still has no idea what to do with me.
Rosemary, a physical therapist or massage therapist trained in myofascial release by John Barnes is very helpful. Normally trained PTs who give strengthening and range exercises won’t break the chord as easily as myofascial release can. Call around local clinics and ask who has training in your area or visit John Barnes website and he may have a list of locally trained therapist. Charlene Zimmerman PT, DPT
Hello,
Like Jared above I am a male in good health who recently developed this syndrom. There have been no other illnesses, symptoms, or events. I developed it under one arm and then developed it under the other arm a few weeks later. I am working with doctors, but currently they are stumped at what might be causing this. Any ideas?
Thanks.
Hi Bill,
I am a healthy adult and have recently developed cording under my left arm. Have you had any success in determining what may have caused this issue? Are you still experiencing these symptoms?
Peter
Here’s another otherwise healthy male, 53 yrs old, who has developed this cord from my armpit to my forearm, symptoms exactly as described above, with no apparent cause. Has anyone had resolution? Based on the article I’m thinking of intentionally trying to snap it and get some relief.
Dear Mike – I would strongly suggest to consult with a Physical therapist on this issue
Thank you for the response Joachim. As I was doing some gentle stretching last night to try to improve mobility (I am playing golf on Sunday), I heard and felt the cord snap about 4-5 inches above my elbow. There is slight bruising at that site, but as reported in your article my range of motion improved immediately and there doesn’t seem to be any other adverse effects. It seems that this syndrome is more common in males than one would think. This is possibly because internists are generally not familiar with the symptoms, and it consequently is simply not diagnosed correctly. I know my doctors were stumped (internist, rheumatologist, and vascular surgeon), and even at this point do not believe it is axillary web syndrome.
Hi Mike, did you find anything out? I’d be interested to know what your result was… I’m an otherwise fit and healthy male (35) and just discovered a “cord” out of the blue about six inches in length about 45 degrees clockwise in from my left armpit on my chest under the skin above my ribcage. It extends straight down from just below my nipple and is invisible, unless I really stretch the skin, then it is slightly noticeable but can be felt. My GP had no idea what it was, and I have an oncology referral in two months. Wondering if I should be getting myself in earlier. Any suggestions are welcome. Was a little stiff/painful stretching which is why I found it at all.
I am a physical therapist who works in a specialty clinic. I frequently treat patients with chording following node removal in both the groin and the axilla. I have found myofascial release as taught by John Barnes essential in successful treatment. Range of motion is often gained only temporarily or with residual pain until the myofascial tissue is released. I have also found the same issues in patients with surgeries anywhere in there body at anytime. Most recently I treated a patient with a 15year old scar on her abdomen to successfully treat her low back pain. There is much we do not know regarding scar tissue and healing and we frequently ignore the myofascial system. Please seek a therapist who specializes in this technique when looking for help with chording. Sincerely Charlene Zimmerman PT, DPT
29 y/o female… Currently suffering from AWS after having 12 right axillary nodes removed for melanoma. It’s absolute hell. I’m only 15 days post surgery and first noticed the AWS on day 12. Hoping for a physical therapy script on Monday. I am terrified about the “pop” for some reason. Thanks for this great article — it shed some light on this awful complication.
50 year old female almost 4 weeks post op (full axillary clearance due to breast cancer). Very informative article thank you. I originally thought that the pain beneath my arm was due to the scar from surgery. However after approx 2 weeks I noticed 2 cords developing, which have now spread to my elbow. It’s painful and I cannot fully extend my arm. I’ve contacted my Macmillan nurse who is arranging for me to have physio. I too am for some reason afraid of the ‘pop’ but if it provides relief I’ll take it!!
I am 42 yo female, bilateral mastectomy, post op 6 weeks now, developed cording only on one side so far approx 3 weeks post op.
PT myofascial release is the only relief I have found. My PT heard or felt the pop during ROM stretch, I was doing breathing exercises at the time and did not notice at all, but ROM improved immediately and the tightness in elbow subsided during that session.
I did not know what to attribute the improvement to until reading these posts – so thank you. Any one have tips on PREVENTING cording? I am worried about appearance of cording on the other side.
Dear Ginger: At this time it is not known if and how cording can be prevented.
I am one year post ALND for breast cancer with removal of 9 nodes. I have noticed over the last 2 weeks that the muscle on the inside of my arm feels tight and is painful to palpate and when stretching my arm all the way. I have full range of motion in my shoulder and no pain there. No swelling or visible cording that I can see but I am not considered skinny. Are the cords always visible and is it common to occur after a year?
Dear Kelly: Cords are not always visible but palpable, and yes, it is possible to develop cords many years post surgery
I had surgery for invasive melanoma on my back in 2005. Lymph node clusters were removed from both armpits. I have suffered with the symptoms you mention here for AWS since that surgery. No doctors I’ve seen have a clue about what I’m feeling. My surgeon said it was probably nerve endings trapped in scar tissue. I describe the hotdog type sensation under my scar. No pain when I’m at rest, but it gets real bad with strenuous work. I don’t feel anything that extends down my arm, but my left hand does ache when pain levels are high. I do have a thin build. Thank You for the info, Ill start over again with my Pain Management Doctor and your article.
I have cording along with whole body lymphedema. I do not have cancer but had a stereotactic biopsy. & a marker left inside my breast for future mammograms. I believe I may be allergic to this marker as my health rapidly declined two weeks after placement. Have you ever heard of this?
Dear Lisa: No, I have not heard of this, but it is certainly possible
Great to find this site, thank you all for contributing 🙂 I’m a 39 year old female who was very active in sports and naturally muscular. I’m 8 weeks post of from left mastectomy and 11nodes removed. I then had a 2nd emergency surgery when the drain removal triggered internal bleeding so the entries site had to be opened, and cleared plus blood transfusion.
Cording was there pretty much from the start in my armpit and bicep and there are times when it extends all the way to my thumb. I have decent movement and my PT is also a lymphoid a specialist so the total focus of my sessions are to clear lymph nodes, exercises are from an instruction sheet 3 times a day. Progress is slow but I have been strongly advised not to rush it due to risk of lymph oedema, sooooo tempted just to push through it. I don’t have much pain but the cording is very visible.
I’m still having chemo and also had it before surgery and this slows recovery. My physio is fully confident that over time it will go, I have one to two lymph Clarence’s session lasting an hour per session plus simple self clearance at home that I do daily. Surprisingly a lot of torso massage is part of it.
I’ll update when I get as close to 100% as possible! Good luck to all of you.
Sorry I should add the torso massages are because the left arm is part of the lymphatic system that covers 75%of the body – left quarter, both legs and much of the torso.
Also, I have found that with my arm bent right up, I can pretty much get full movement so it’s a good way to keep the shoulder and muscles stretched an ready for more range.
Finding out more on here than what my doctors could tell me. Can you have more than one in the same area? This is painful, I have four kids I can no longer keep up with. Please tell it won’t last long.
Hi, thanks for the article. I developed the cording, pain and movement restrictions in my arm before lymph node removal following diagnosis of inflammatory breast cancer. The cording in my arm gradually disappeared over the chemotherapy. I still have neck pain though and when I bend my head to the side I think I see a similar cord. Have you seen cording extending into the neck?
Yes, this is possible
I currently have a very tight cord from my right axilla to my wrist. I have had no surgical intervention but have had recurrent chest infections. Is there any underlying cause i should be investigated for? Thank you for the information so far.
Dear Ali: I am unable to answer this question and would recommend you contacting your physican.
Thank you Joachim, I guess I was just wondering if you (or anyone else) had ever heard of this condition occuring without prior surgical intervention? Everything I find relates to it being a post-op side effect. I am seeing my GP soon.
43 year old male and I discovered a cord last week. I have no pain, no limitation in movement but also cannot think of any injury that would be considered a trigger for this. There seems to be very little information around for why men develop these when there has been no obvious cause.
How common is this in men?
Btw off to see the doc this week.
Dear Ben: There is no research available on the incidence of AWS in male patients. However, from my own experience I can tell you that it would be very rare.
I am a 31 year old male, and after looking at many photos and reading websites I also think I have AWS. I have never had surgery of any kind, and this cord has been under my left armpit since I was in high school. I recently started working out and the cord does hurt after many pushups and bicep curls. I just started researching this because I thought some kind of tendon had popped out of place. I do have family history of lymphedema and varicose veins.
Hi Ben,
I’d be interested to know what your result was… I’m an otherwise fit and healthy male (35) and just discovered a “cord” out of the blue about six inches in length about 45 degrees clockwise in from my left armpit on my chest under the skin above my ribcage. It extends straight down from just below my nipple and is invisible, unless I really stretch the skin, then it is slightly noticeable but can be felt. My GP had no idea what it was, and I have an oncology referral in two months. Wondering if I should be getting myself in earlier. Any suggestions are welcome. Was a little stiff/painful stretching which is why I found it at all.
Hi – I am currently suffering from a recurrence of AWS 15 months after breast cancer surgery (9 lymph nodes removed). Despite my doctors’ assurances – I am scared to death of ultimately developing lymphedema. The axillary cord has receded after a month – but I am now experiencing pain along my forearm down to the blood vessels on the top of my hand which seems to be a little bit swollen along the veins. Is anyone familiar with these symptoms?
For those of you suffering from AWS without a known cause – you may want to read a dissertation entitled “Axillary Web Syndrome Ongoing Medical Evaluation” by Linda Ann Koehler and an article entitled “Essential Lymphedema Information for All Health Care Providers…” by Dr. Judith Nudelman – both available on-line.
Good luck to all of us suffering from this annoying disorder. Hopefully someday AWS will receive more attention and insurance will provide more benefits for essential P.T.
Hi Mr. Zuther,
I have AWS + lymphedema from BC, 23 nodes removed, right (dominant) arm.
I developed AWS very early after surgery (but didn’t know what it was) and developed lymphedema 2 months after surgery.
Now, more than a year after surgery, I still have the AWS. I do try to stretch it daily, and have tried to make it pop myself (but it hasn’t). How do I get this thing to go away? Or will it go away? The drs said it would go away on its own, but it hasn’t….
Dear Karen: I would suggest you seek the services of a Physical Therapist who is trained in AWS. The issue may solve itself, but it is always good to have a knowledgeable therapist working on it
Thank you for opening my eyes to this very rare complication of the surgery I had a little over a month ago. I was made to feel like I just wanted attention. It is very painful. I have four very visible cords and am seeking a Physical Therapist that is knowledable about this condition for treatment. Pain pills do not do the job!
I didn’t have this fortunately. But my surgeon was pretty adamant that I did the exercises regularly on my right arm. I started those exercises within a few days post-op and was in excruciating pain. Stopped them for a week and started again week 3 post-op. When I went in to see my surgeon 4 weeks post-op I was able to straighten my arm all the way above my head and out to the side. I didn’t want to be the one that had limited motion on any part of my body.
However, now with the lymphedema kicking in more over the past 6 months to a year, it is very VERY painful to lift arm all the way up. Skin tightening due to the swelling. BUT I DO IT, I force myself to keep that arm moving and working no matter what!
🙂
I think that sometimes maybe those cords are due to how much one does the stretching exercises sent home and how soon that we do them after surgery.
Just a thought is all.
How can someone tell the difference between axillary cord syndrome and Mondors disease? Are they treated the same?
thank-you
Mondor’s disease affects the superficial veins in form of a thrombophlebitis. This condition can not be treated with the techniques used for AWS
I have cording under my underarm down my inner arm as you describe in your article. I did not have breast cancer or any treatment whatsoever prior.
I’ve been using an anti-inflammatory cream to minimize the cording and it is going away. Do you know why I would have had this happen.
I have colitis proctitis = don’t know if that is relevant.
Dear Rena: To my knowledge there is no evidence of colitis proctosis being the cause for cording, but then again anything is possible.
I just read up about AWS and it sounds very similar to what I’m experiencing, but would like an opinion. Around 3 months ago my hand was hurting and was slightly swollen, after that all of a sudden I had a large red line running up the inside of my arm and it kept moving up, eventually to my underarm. At the very top of my arm I had a large lump under the skin (felt like a worm under my skin), and it was warm. swollen, and my vein was visible all the way down the arm.
At first the ER treated me for a blood clot, but then the Doppler showed it was not a DVT, and then they moved me over to a diagnosis of Phlebitis and treated me with an IV drip for 7 days with an anti inflammatory and then followed by a 5 day oral antibiotic. The problem was getting better but did not fully go away, and the doctor suggested I see my Oncologist, he was worried perhaps it was a lymph node blockage or a new cancer. Oncologist said that I had definitely had a superficial blood clot and sent me to the vein doctor, who also agreed. They started testing me for a cancer occurrence (EA markers, CT, MRI, US), markers slightly elevated but everything else was normal.
In the meantime, the swelling has moved down to my fingers, which are swollen and had red lines on them, back to the ER and another drip, but it is not working. Now the swelling is moving back up my hand and the vein is pulling again.
HELP, please someone tell me what is going on??
Thanks
Shelley
I am uunable to make any diagnosis, however, the symptoms you are describing are indicative for a phlebitis.
Hi Joachim,
Thanks for getting back to me.
They have been treating me for Phlebitis but it’s not going away. In fact, today it seems to have started back again to the original spot where it first started, and the vein or cord is back again.
Shelley
Hi, im a fit healthy 40yr old, during training for a triathlon I got a bleed in my bicep from swimming, and 2 weeks later several cords running down may armmappeared. It is stopping me swim as I can no longer straighten my arm and its faily painful when i stretch. By the sounds of it the cord snapping (whilst sounding horrible) seems like a good thing – is it advisable to bring this on to get my movement back?
While cording could be the reason for your symptoms, I would suggest seeking the opinion of a certified therapist familiar with cording.
I had a axillary tumor removed in my left armpit, along with one node for testing in Feb of this year. About three weeks ago I noticed my left arm feels very tight from the armpit all the way down my inner arm, across the forearm, all the way to the base of my thumb. I can feel a very small vein like cord all the way down. It also hurts and sends a weird feeling down my arm if I touch the scar of my incision site. The part that puzzles me is that it has been 7 months since my surgery.
I also have cording in my left arm. I have not had breast cancer or lymph nodes removed. I am a 46 year old female. Has anyone figured out what can cause this? I do very heavy lifting at work could this be the cause or is there some underlying condition that can cause this? I have been to four doctors and none of them know why.
The exact causes are still unknown.
I am a lymphedema therapist. We treat patients post mastectomy with axillary cording very frequently. We occasionally have difficulty with documentation of exactly what we are seeing with description of the cord, “dimpling” of the skin, or when we can see the skin is pulled taut from cord but not palpable. We take pictures frequently of the changes due to difficulty with verbalizing it. we have developed great techniques that improve function and ROM but the cord does not completely go away. A frequent question is whether or not the cord will return?? Do you have more literature on axillary cording/webbing?
Hi im 19 and a few weeks ago I felt a knot under my arm. I thought it was a boil or an ingrown hair of some sort but then I noticed a vein coming from it that extended into my bicep. And now I have another knot on my inner bicep attached to the vein any idea what this could be. I dont believe I have cancer but I really need answers.
Dear Gerald: There could be a number of reasons for the occurrence of the symptoms you described. I would suggest you consult with a vascular specialist to investigate.
Hi – I am a 49-year-old female who has had a double mastectomy with right side node removal on Jan. 8, 2014. I am experiencing axillary cording. I am not currently seeing a PT but I am doing stretching exercises every day to help. Last night while I was doing my exercises a heard a snap my range of motion improved only slightly. I stopped exercising at that point (exercises include wall craws both abduction and flexion – this is what I was doing when it snapped). This morning my arm feels tighter and there is slight bruising where I felt the cord snap. My arm is very tight when I try to lift it straight above my head and I feel like another cord needs to snap should I continue my exercises or stop for the time being. I am going to have an u/s tomorrow to make sure there isn’t a blood clot (this was scheduled before the cord snapped my primary care physician just wants to make sure a clot isn’t present)
A month ago I had a large knot removed from my right axilla (noticed heavy odor from that side only). Results came back benign cyst with a piece of lymphnode and muscle attached. I have had SEVERE pain down the interior part of my arm since. (Incision site healed perfectly fine rather quickly). After a couple weeks of very limited range of motion and dealing with the pain, I was able to feel several ‘bb’-sized knots (at inside of elbow) in what I assumed was a vein. I have seen my surgeon several times to express my fears an concerns. He ordered an x-ray and gave me a consult for neurologist for nerve conduction test and cardiologist. Just today, I felt the same knots running down my arm from the armpit. Maybe what my issue is is cording as mentioned on this site/post. I did request physical therapy also and his response was to just grap things at home (like cup, purse, brush, etc). Yeah, well…I USE the hand and arm daily as much as I am able, but I am very limited in my ability with this side and am quite frustrated! 🙁
It certainly sounds like cording. I would strongly suggest contacting a Physical Therapist familiar with that issue.
I am also unable to straighten my arm completely. The doctor applied a Coban dressing in hopes to stretch the muscles, with no result.
Hi –
My pain began two days after my lumpectomy and removal of only 4 lymph nodes. I already had neck shoulder problems on that side and now have been dealing with this for over six weeks.
I was in a lot of pain for several weeks before my doctors even knew what to do. They first sent me to a Chiropractor and he really did not know what to do. He thought I hyperextended my neck and shoulder during the surgery.
Luckily my Oncologist (two weeks after surgery and pain) referred me to OT. I am doing daily stretching exercises which has improved my range of motion for my radiation treatments which I begin next week. I still have pain in my neck and shoulders, muscle spasms and tightness down my arm. The pain is a little better. I am taking naproxen, Tylenol, and valium to calm the muscles.
It is so bad that I am on leave from my job for two months in order to calm the muscles and pain. I sit at a computer all day and it was aggregating the swelling under my arm and my pain. I have pain and pulling from my breast all the way to my wrist.
This article really helped me in understanding this condition. The surgeon or OT did not do a good job in explaining this condition nor do they have any literature on this. This was also never explained to me as a side effect of the surgery.
I have not had breast cancer or melanoma; however, I had chemo 9 years ago for Hodgkin’s lymphoma and more than halfway into Tx, I developed chemical phlebitis and had a PICC line put in.
Two weeks ago I drove myself to the ER because I felt like I was dying and had an emergency appendectomy the next morning (perforated, retrocaecal, gangrenous appendix which did not show up on the CT scan). My IV was put in on a Friday in the ER, and on Sunday it was removed in the hospital after surgery because the nurse thought it looked inflamed (although there was no pain or swelling). Immediately upon removal, my right arm began to ache and I began to notice than stretching my arm in even the simplest movement caused me distress. There was a palpable venous cord; the throbbing pain has increased over the past two weeks, and the motor function in my arm and hand has become increasingly compromised. I cannot place my right hand on a flat surface perpendicularly; there is a space between the palm and the table unlike my left arm. It feels as if tendons in my arm had been shortened and when I reach beyond their capability, I am jerked back by the pain. I mentioned this to three nurses and the resident who saw me before I was released, and all of them dismissed my concerns, telling me that it was probably a hematoma that would be reabsorbed into the body in a few days. That has been anything but true for me.
This is the only website I found that describes the symptoms I’m having, but I’m confused because my circumstances are wholly different than those described here. I also know that the Levaquin that I was given intravenously can cause severe tendonitis, but none of the doctors I have seen so far have a clue, which has forced me to do my own homework and try to figure out—without the benefit of a medical degree—just what is wrong with me: nerve damage? Levaquin toxcicity? Superficial thrombophlebitis?
This from Medscape: Thrombosis and thrombophlebitis of the superficial venous system receive little attention in medical and surgical textbooks. However, thrombophlebitis is encountered frequently and, although it is usually a benign, self-limiting disease, it can be recurrent and tenaciously persistent, at times causing significant incapacitation. (See Epidemiology and Prognosis.)
I have seen two doctors who were CLUELESS and did nothing but pass the buck. Next week I see a clinical neurologist, followed by a vascular surgeon to get arterial and venous duplex scans, and the week after, a hand surgeon. I’m hoping one of these doctors will shed light on my situation. However, I feel it’s incumbent upon me describe my situation, rare as it might be, so that if someone identifies who has been blown off by the medical establishment because they do not fit the paradigm for dis-ease, they will take heart in knowing that they are not alone.
If anyone has anything to add here I’d be most grateful, and apologies in advance for upsetting anyone who feels that I hijacked this thread.
Best,
Kim
Hello.
That was a really informative article. After I had my right axillary lymph nodes removed, I had cording that looked a lot like the picture on this page. I also had some on my bicep and tricep. After three months of physical therapy, I’ve regained full range of motion and the cording isn’t visible anymore. However, the area wrapping around my armpit still feels “tight.” Do you think this is cording? If so, do you have any advice?
Thank you for your time.
It is impossible for me confirming the presence of cording without seeing you personally. I would suggest consulting a therapist in this regard. The link on top of this page labeled “find a therapist” assists you in locating a trained lymphedema therapist in your area.
I brought this up with a trained lymphedema therapist before I stopped seeing her, but she wasn’t sure if it was cording or something else. (At her recommendation, I stopped seeing her once I regained full range of motion.)
I was just wondering if you had heard of anything like tightness around the armpit after lymphectomy. But I completely understand needing to see someone before saying one way or the other. I greatly appreciate your time. Thank you. 🙂
I am a 52 year old Male and found a single cord 2 weeks ago, going from my right armpit to elbow. I have never had any surgery in my life except for a BCC Removal and associated skin flap on my forehead 10 weeks ago. However 2 days before I found this armpit cord I did drag a 200 pound treadmill from one room to another whilst redecorating and this may have caused stress in that area. That’s my only theory as to what may have caused enough trauma to that area to induce a reaction like cording (which seems essentially to be a post breast surgery condition). Does this situation ring true with any males who have this condition? Many thanks for any advice.
Hi. I had what i thought was an ingrown hair in my left arm pit for 5 years. (Yes, I know..) I would continually squeeze it and get the hair out… I recently was laying on my side and it popped on it own and appeared infected. Now I am not so sure it was an ingrown hair. Maybe an infected lymph node? Anyway. I now have a cord running from my armpit to my elbow and to my wrist/thumb area. It is tight, and when i try to extend my arm up, it feels sore along that cord. if I press on the cord, it also feels sore. Is this AWS? It looks just like the photo you have. If so, should I get treatment for it? I am confused because it seems to have appeared after that lump ruptured. And I went to two doctors who just said to try antibiotics… but I don’t see an infection any longer, and I am breastfeeding my infant son and worried about the antibiotics. I dont see any information on this other than related to surgeries and cancer.
Lymphedema can have other causes than surgery and cancer – see primary lymphedema. I would suggest you consult with a trained and certified lymphedema therapist. In order to locate a therapist in your area, please click on the :Find a Therapist” link on top of this page.
I had posted months ago . I am now 47. I has cording but never had breast cancer or lymph nodes removed. My cording was confirmed by a lymph node specialist who treats patience that develop cording after lymph node removal. She said my cording was caused by the heavy lifting I do at work . I am a female and lifted up to 60 pounds all day long.
Any thoughts on this? Also she said they have seen cording in necks from heavy lifting
I had several lymph nodes removed due to a breast cancer diagnosis. Several weeks later, I noticed a raised cord beneath the skin going from my node scar down to my nipple. My surgeon told me that it was axillary cording and that it was rare. A week or so later it showed up in my upper arm and traveled down to my wrist. Very painful and it definitely limited my movement. I tried keeping it stretched out myself but any headway I made was shortlived. I went to see a physical therapist who specializes in lymphedema. She performed myofascial release massage on my arm and it helped tremendously! My partner came to an appointment with me so this could be done at home as well. I really don’t believe that it would have gone away on its own. I am amazed at how little is known about what this actually is.
I have no doubt i have AWS. It started 5 weeks ago with a light tight skin sensation under my armpit. 2 cords later appeared in my armpit and extended gradually down to my wrist. I had am echography identifiing the lymph vessels and an MRI. Have a mammography and echography of the breasts this week.
Of course I am worried about it possibly being cancer.
Can anyone reassure me?
Has AWS ever been associated with tennis players or runners. I jogged over long periods of time and in the heat before it happened.
Thank you for your advice
Dear Daana – the symptoms you describe certainly point to AWS
27 y.o. male. No previous signs or symptoms. 2 full weeks with armpit lump/cording to elbow. Blood work normal.
There’s a lot of males posting in this forum for as rare as they say this condition is in males…hmm.
Please help.
Cory, do you have any results or resolution on you cording?
I have had a sudden onset of one of these cords on my left breast to my inner armpit, I have not had any surgery or biopsy, I have had a tetanus shot about 7 days before the cord appeared. should I be worried, should I go to the hospital?
Dear Samantha: I would suggest seeing a therapist familiar with this condition. There are ways to treat and manage it.
Hi Joe, just to let you know I have just discovered cording in my right arm where I have had all my chemo and bloods taken. This is supposed to be my GOOD arm as the left one is where my lymph nodes have been removed after my mastectomy. Is this normal? Can you give me a reason why this is happening on the opposite side? Going to see my physio next week.
Marie. (Mark’smum)
Dear Marie: While I heard this happening to some patients, it is very rare to appear on the opposite side. I would recommend stretching exercises for the upper extremities, swimming or Yoga. Here is a link to an article covering exercises: https://www.lymphedemablog.com/2011/01/06/decongestive-and-breathing-exercises-for-lymphedema/
Hope all is well,
Joe
Thank you for sharing this article. I have been “suffering” with AWS for over two years. I was told the cords would go away on their own, however this has not been the case for me. I went to a physical therapist and was told after 8 weeks that I had good range of motion and there wasn’t anything else that could be done to get rid of the cords or the pain. The pain extends to my elbow, thumb and pointer finger and travels down my chest wall to my ribs. I stretch daily and exercise a few times a week, but still no relief. I also have MS so pain meds, etc. are not something I want to take with the drug I take for the MS. Is there anything you could suggest that may help release the cords?
I would recommend stretching exercises for the arm – here is a link to some exercises: https://www.lymphedemablog.com/2011/01/06/decongestive-and-breathing-exercises-for-lymphedema/
Swimming and Yoga are beneficial as well.
I seem to have developed cording (along my right axilla down to my medial elbow) after heavy snow shoveling followed by being sick in bed for 3 days with the flu. Went to ER and they thought Thrombophlebitis but vascular ultrasound was normal. They left me with an unknown diagnosis. The cords are very painful to the touch (especially putting deodorant on) as well as with lifting heavy objects or excessive stretching of the arm. There is a history of Phlebitis in the family. I have no history of breast surgery, etc. Since men are also similarly reporting signs and symptoms o axillary web syndrome, do you think it is a problem with the lymphatic system??
It could be an issue with the lymphatic system, but without knowing you personally it is very difficult to say
Hi I had a bilateral mastectomy 6 mths ago, 6 nodes from R side and just sentinel node from L. But have had major cording issues on my left side. Have been seeing a lymphodema specialist for months, had plenty of pops etc, but still at least half a dozen vid able at elbow and stretching down to thumb. A couple of weeks ago developed swelling in that arm and cords were quite inflammed at the time. Swelling has been persisting for several weeks now. My question is has anyone seen swelling with cording, keeping in mind only 1 lymph node removed! Ps, no DVT as has been all checked out.
This article and site has been very informative. I went to the doctor about a month ago to have an infected cyst under my armpit lanced. Because the cyst didn’t secrete any fluids and felt hard, he became concerned and decided to dig the whole thing out. The pathology came back benign and no lymph nodes were taken out. Two weeks after surgery my arm started to really hurt. It felt tight and swollen and my veins ached. I couldn’t stretch my arm all the way out. I am wondering if this AWS is what I am experiencing. I have some scar tissue under my armpit now. Do you think the scar tissue is what is causing this? I really hope it is not lymphedema. Help! I am scared.
Dear Shannon: Without knowing you personally it is not possible to determine if this is AWS or lymphedema. I would suggest you seek the services of a trained lymphedema therapist. Here is a link assisting you in locating a therapist in your area: https://www.lymphedemablog.com/find-a-therapist/
Thank you, Joachim, for your response. I really appreciate it. I have already seen two doctors since experiencing these symptoms and they are unsure of what is happening to my arm. My arm feels swollen, heavy and tight specially in the lower part of the arm. My veins ache and when I stretch my arm completely out it hurts. I have not seen any “cords” in my arm but could they still be there even though they are not visible? Also is it possible to experience AWS and some lymphedema at the same time? Because after researching it, I seem to have symptoms of both. I am going to try and find a reputable lymphedema therapist ASAP. I was wondering though in your experience, does the pain ever go away? That is what is upsetting me more than anything. I just want to know that it will eventually get and feel better. Also, my doctors seem to think since I didn’t have my lymph nodes removed than I can’t have lymphedema but what about the scar tissue under my arm pit and the trauma from the surgery? Any insight would be GREATLY appreciated. Thank you, Shannon
I did look at both my armpits yesterday, and there seems to appear a cord, near the scar tissue in my arm pit, that runs down my arm and disappears. Originally I just thought it was the vein all messed up because the scar tissue seems to be pressing on it. But it is very similar to the picture on this site. I am a very thin 42 year old so it makes since I can see it and that it does occur more often in thinner people. I am frustrated, because I have had to discover this condition on my own after having been to two doctors who never mentioned it and then the 3rd doctor who had placed me in the predicament in the first place with the unnecessary surgery. I work as a server in a restaurant, is it advisable I go back to work and are there any precautions that I take? Do you think physical therapy is beneficial for AWS or will it go away on its own. One of my docs wants for me to have an ultrasound on my arm pit but I am wondering how necessary that is especially since I have to pay for most of it out of pocket. I just want this horrible condition to go away!!! Any insight at all would be appreciated. Thank you, Shannon
Dear Shannon: Ultrasound is an option should it be AWS. I would recommend seeking the advice of a Physical Therapist familiar with this condition.
Meeting with a physical therapist today and will keep my ultrasound appt. for tmrw. Just got off the phone with one of my doctors and she told me that AWS doesn’t get better that it is a progressive condition. She doesn’t seem to think I have AWS because the surgery wasn’t near lymph nodes in my arm pit. I am so confused. Everything that I have read about AWS states that it does get better that it just takes time. Am I missing something here? I am still just as clueless as to what is wrong with my arm? 🙁
Just got back from the physical therapist, and I feel like a new person! She was able to see a few tiny cords in my arm forming from the scar tissue and through stretching them she was able to pop one of the cords. We actually heard it pop. My mobility increased immediately and the pain is definitely subsiding. I am so grateful to have some relief from this. I am going to continue with her stretching recommendations and will see her again in a week, but I feel now that it is going to just keep on improving from here. Yay!!!
Did anyone find a reason for their condition? I am a medical student and there is no literature on the subject except for 1 case report. I might be willing to do a summary of all your different stories so physicians might be able to know what to do in the future
I should add that I have it too
Joshua, my name is Kelly and I have posted twice on here. I would give you my story . In 2013 I developed auxillary web syndrome from repedative heavy lifting. I have no cancer and no lymph nodes removed . I went to sister Kenny . She said I was her first case of someone that developed this without lymph node removal . I have been fine ever sense I stopped the heavy lifting
I’m 64 a male and just a week or so ago my left armpit had a slight, very slight, pain to it. So slight I just assumed it was from swing the golf club at the range. I also had a small cyst removed from my right armpit 6 months ago and worried that it may be one in my left armpit now.
Well I was putting deodorant on and again it felt as if there was some slight pain so I felt it to see if there was a bump there and instead there was what felt like a cord or string or plant root or something under the skin and it was very taught. The source of the pain was in this general area as well.
I’m a guy, not having any breast cancer, no surgeries ever in my life.
I have 3 herniated discs both knees are bone to bone and I wear a brace on my right knee and both wrists have some carpal tunnel pain.
What is this? Why is it in my armpit? What do I do?
I see the doc in early November so I’ll show it to him then.
How does this happen to a man without breast cancer or any operation in the pectoral area?
Any help would be great to try to under stand what’s happening.
Stephen
Dear Stephen: Cording is possible even without a history of breast cancer surgery. I would suggest you see a PT, who is familiar with this – you may use the link on top of this page labeled “Find a Therapist” to locate a therapist in your area.
I am a certified lymphedema therapist/physical therapist and have treated many patients with AWS. My question: do you have a study that supports or contradicts the use of therapeutic ultrasound for cording? I have had several lymphedema patients whose physicians ordered ultrasound for their AWS, but I hesitated to use the modality for fear that the heat would exacerbate their lymphedema.
I am unaware of studies on the topic of lymphedema and cording. However, ultrasound is known to have no adverse effects on lymphedema http://www.ncbi.nlm.nih.gov/pubmed/8258986
Can I bust my cord myself? would there be complications from that?
I would leave that up to a therapist
Hello there, I like to share a publication on “a systematic review on axillary web syndrome” for those who may be interested: http://www.ncbi.nlm.nih.gov/pubmed/25682072
Saw a lot of posts on aws cording without any hx of lymph node surgery. Has anyone found anymore information on this? Does having had aws suggest you have lymphedema or at more risk for developing lymphedema? I am a 30 year old very active woman without any history of cancer or lymph issues but developed aws last year after doing a lot of strenuous exercise. I also *think* I had an ingrown hair in my arm pit. After a few months and after several md consultations, medical testings, they concluded that I had thoracic outlet syndrome arterial version. I was also experiencing numbness and tingling down my ulnar aspect of my arm. I spoke with a coworker who is lymphedema certified because I recognized the cording as aws. She agreed that it was aws and told me to do scar massage which got rid of it. Fast forward a year and I am slowly getting back to working out but when I do my affected arm feels tight and slightly swollen over the area that had the cording especially around the antecubital fossa. Does anyone have any type of information or feedback on this case scenario? Coincidentally I am taking a lymphedema seminar right now from the academy of lymphatic studies. The instructor is also baffled by this scenario. This type of progression with aws seems to be more common than recognized and would be great for more research. I would be happy to share more information with anyone wanting to do further investigation. Thank you, Susan-OT