5 Things To Know About Cording
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Axillary Web Syndrome, or Cording, is commonly associated as a side effect of sentinel lymph node biopsy or axillary lymph node dissection. However, it can actually occur in people with breast cancer post-treatment. We spoke to Lindsay Davey, Physiotherapist and Clinic Director at Toronto Physiotherapy, to find out more about the symptoms of cording and how it can be both treated and prevented.
WHAT ARE THE TYPICAL SYMPTOMS?
Cording can take on a few different forms. It can be several cord-like bands or just a single one or two. They can feel like a tight band or ‘ropeyness’ in the armpit, upper arm, elbow, or even the wrist/thumb. Cording can also be felt on the trunk as well, typically lower than the mastectomy scar or breast, or under the chest pectoral muscle at the junction of the trunk and arm. They typically feel like a tight cord-like structure, quite thin and floss-like in nature, that does not feel it is stretched easily by classic chest and arm stretches. It can limit the range of motion of the arm, or, can just make it tighter in feeling without limiting range.
HOW COMMON IS IT?
There are no concrete numbers on cording in terms of prevalence after breast cancer treatment, but it is not uncommon and often misdiagnosed as merely ‘tension’ or ‘tightness’ from surgery and/or radiation. Given cording is typically self-limiting (meaning, if given enough time and with adherence to range of motion and stretching exercises, it will typically self-resolve), many patients may have it but never seek treatment for it. Cording can occur in those with sentinel node biopsies, more advanced node dissections, mastectomy and lumpectomy patients, and those that do and do not receive radiation. Like many side-effects of treatment in breast cancer patients, it is not fully understood as to why some people experience this and others do not.
ARE THERE ANY WAYS TO PREVENT IT?
I would only recommend that patients keep up with their prescribed range of motion exercises post-op and post-radiation, to best ensure that they stay as loose as possible. Other that than, we haven’t found any hard and fast rules about any particular preventative measures that will guarantee prevention of cording symptoms, unfortunately. Early detection is always key to early/most effective treatment, as with many treatment-related side-effects.
HOW IS IT TREATED?
Cording can be treated with a number of different approaches, each one with the potential to resolve the symptoms, or in combination. Options include cross-friction massage across palpable corded areas, stretching the cord to the point of tension and then releasing this stretch, and alternating between these positions of tension and slack. Other options include tugging the skin itself so that the fascial bands under the skin are put on tension (this is most easily done with a therapist who can provide counter pressure most effectively). Range of motion movements of the arm, while lying down with the knees flopped in the opposite direction, can provide additional tension to the cords and potentially help their release. Additionally, use of the arm and classic stretch positions as instructed to patients after surgery are also beneficial in general, with many cords self-resolving with time and activities of daily living alone.
WHAT SHOULD EVERYONE KNOW ABOUT CORDING?
Cording, while on our risk factor list for lymphedema, does not present a major risk factor for other side effects of treatment, and other than being restrictive and uncomfortable, we don’t want women overly worrisome about this side effect. Treatment is possible and effective in experienced hands if a patient wishes to have this side effect addressed and to get the self-help techniques that can be additionally beneficial.
Lindsay Davey, MSCPT, MSC, CDT is the Owner and Director of Toronto Physiotherapy. She is a Registered Physiotherapist with numerous post-graduate certifications including Combined Decongestive Therapy for lymphedema and lipedema treatment. For more info. on Lindsay and her practice, click here.