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Pre treatment

Visible string like cords in upper arm and elbow

Axillary web syndrome (or cording as it is commonly known as) is a condition which can occur following surgery for breast cancer and is believed to be directly related to removal of lymph nodes from the armpit region (axilla).


Symptoms of this condition includes:

  • Restricted ranges of motion in the shoulder and/or elbow and wrist joints. In particular combined sideways elevation (abduction), and elbow extension are limited.

  • Pain associated with arm movement and stretch which can sometimes interfere with sleep and markedly restrict everyday activities, such as dressing and combing hair

  • String-like cords are often felt in the armpit, down the inside of the arm and/or in the elbow (cubital fossa). Occassionally cords may be present in the chest wall or thorax when the arm is on stretch.


The incidence of A.W.S (Axillary Web Syndrome) varies greatly in research statistics and has been reported as occcurring in anywhere from 6% to 20% of women who have had an axillary node dissection.


Symptoms are reported in much of the literature to resolve spontaneously in about 3 months, but clinically therapists find that symptoms can continue for many months, particularly if untreated in the early stages. In a few cases, cords that seem to have been resolved can reappear after radiotherapy is completed or after an incident such as vigorous over stretching.


The cords are believed to be due to surgically cut non-functioning lymphatic vessels and/or veins that have hardened (sclerosed) and have developed fatty scar tissue which becomes attached to tissue in the armpit. When the arm is lifted, this tissue is on stretch which then pulls on the scarred vessels.


Treatment by therapists includes moist heat, stretches, local massage, kinesio-taping and home exercises. The use of low level laser therapy in the treatment of cording was pioneered at our clinic in 1998, and has been used successfully in conjunction with manual techniques to reduce symptoms quickly. Often only 3-4 treatments are required before full range of movement is achieved. In some cases our clients have had dramatic improvement after a single session of laser therapy.

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