What is Cording After Breast Cancer?
This post is for anyone going through breast cancer treatment involving lymph node removal, anyone treating and working with this patient group. Axillary Web Syndrome, also known as cording, is a common side effect following breast cancer surgery. Surprisingly it is not spoken much about. In this blog post I will discuss what cording is and how it occurs as well as how we can treat it.
What is Cording?
Cording most commonly occurs following axillary lymph node dissection. This is a type of surgery used in the treatment of breast cancer where lymph nodes are removed. The nodes are removed because they are suspected to be affected by cancer.
Cording appears just like the name refers, as a tight cord running often from the armpit/scar down into the arm. It may just extend in the axillary region, but can also extend into the inside of the elbow and down to the wrist. This will make it hard to elevate the arm as the cord/s (can be multiple) will limit the range of movement in the shoulder. The cord can also run downwards from the scar along the chest wall.
Cords are thought to be connective tissue which wraps around vessels, lymph vessels and nerves. And this is what creates the rope or cord like feeling. However this is not fully understood yet.s
Most commonly cording occurs around 2-8 weeks post surgery. However, it can also occur months to years later. The incidence rate lies around 50% and the risk is higher for lymph node dissection versus lymph node biopsy. Some other risk factors for developing cording include low BMI, younger age, higher number (out of total amount) of lymph nodes remove and exercising frequently.
How to Diagnose Cording
To detect cording in the axilla you want to bring your arm out towards the side (Abduct) and then straighten the elbow. If cording is present you will feel these in the armpit and potentially in the inside of the elbow. It is often painful to stretch the arm out, especially towards the side.
The early literature discussing cording suggested that it is a condition that will usually improve within 3 months by itself. Unfortunately evidence now show that this is not necessarily the case. Cording can be present for years and may reoccur a long time down the line. The presence of cording can really impact overall function as well as lead to more persistent changes in neuromuscular control.
Treatment of Cording
Overall physiotherapy is a safe and effective treatment method in cording. And there are studies showing that physiotherapy can aid in resolving the cords quicker than no treatment. There is no ‘gold standard’ treatment method for physiotherapists. A combination of education, exercises, soft tissue mobilisation, myofascial release and cord manipulation and stretching can be applied As each person presenting with cording is individual and have different needs the treatment method applied will differ to accommodate for these changes. Scar tissue work can also be beneficial as scar tightness can limit motion. Manual therapy to surrounding joints can also help to reduce pain in the surrounding joints. Whilst undergoing the physiotherapy treatment you may hear a pop or snap and have a sudden release of tension and increase in movement.
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Koehler, L.A. et al. (2019) Axillary web syndrome following breast cancer surgery: symptoms, complications, and management strategies. Breast Cancer - Targets and Therapy, 11, pp. 13-19.