Have you had surgery for breast cancer? Or is someone you know going through this experience? A few days, maybe a few weeks after surgery, did you start to feel a tight string running down your arm from your armpit? Does this pain and tightness get worse when you try to raise your arm? This is a common experience for many people. Don't worry. This can be a normal side effect of surgery. In medical terms, we call this condition Axillary Web Syndrome (AWS). But in common parlance, it is called 'Cording'. Let's talk about it simply today.
Let's first see why this happens.
To understand this, you need to have a little idea about the lymph system in our body. Simply put, this is an important part of our body's immune system. Just like a network of blood vessels, there is a network of lymph vessels and small glands called lymph nodes spread throughout our body. We also call these 'kuddati' in Sinhala.
One of the main functions of this system is to remove excess fluid from the body and filter out things like germs, bacteria, and damaged cells. It's like a 'garbage management system' in our body.
Sometimes breast cancer cells can spread to these lymph nodes, or lymph nodes. So the doctors who treat you will want to know if the cancer has spread that way. They will use that information to create the most appropriate treatment plan for you.
What is the specific cause of cording?
Cording is a common side effect of surgery to remove lymph nodes (lumps) from the armpit to check for breast cancer.
Your doctor may recommend one of two types of surgery for you:
1. Sentinel Lymph Node Biopsy (SLNB): This involves removing and examining only one or two of the most important nodes closest to the cancer.
2. Axillary Lymph Node Dissection (ALND): Here, a large number of nodes are removed.
Many people undergoing cancer treatment have to undergo one or both of these surgeries. The more tissue the doctor removes, the more likely it is that cording will occur. But remember, even if just one tissue is removed, this condition can occur.
Here's what happens: When a pimple is removed from the armpit, the delicate lymphatic vessels that were connected to it are damaged. This damage causes those vessels to tighten over time, becoming like dried threads. It's those tightened vessels that feel like they're being pulled along our arm.
What are the symptoms of cording? How exactly does it feel?
These symptoms usually begin to appear within a few days or two to three weeks after surgery. However, very rarely, cases have been reported where they began months later.
If you suspect you have this condition, keep an eye out for these symptoms.
| Symptom | Description |
|---|---|
| Pain when raising the arm | The first thing you feel is a pain in your armpit when you try to raise your arm above your head. |
| Tightness and pulling | It feels like a tight string or cord is pulling from the area where the surgery was performed, all the way to the elbow, and possibly the wrist. Some people may also feel this pulling in the chest area. |
| Looking out and being touched | Over the course of a few weeks, these 'cords' become tighter and tighter, becoming visible and curling under the skin. You can feel them when you touch them with your hand. |
| Restriction of movement | This tightness and pain make it difficult to raise the arm above shoulder level or fully extend the elbow. This can even make it difficult to perform daily tasks. |
This can be a big problem, especially if you are undergoing radiation therapy at the same time, as that treatment requires you to raise your arm above your head.
Don't worry! There are effective treatments for this.
It's normal to feel scared when you hear about this. But the good news is that this condition can be very successfully treated with physical therapy . Symptoms usually disappear completely within a few treatment sessions, or even a few months.
What you should do is talk to your doctor and ask for a referral to a physical therapist, nurse, or other doctor who has experience with cording conditions.
Your treatment plan may include one or more of these things.
| Treatment method | A simple explanation |
|---|---|
| Stretching exercises | This is the key to recovery. Your physical therapist will teach you special exercises to stretch these tight cords. It is important to continue doing these at home. |
| Painkillers | You may experience some discomfort or pain while exercising, so your doctor may advise you to take a painkiller before treatment or exercise. |
| Swimming | Swimming is a great way to help regain arm movement and reduce pain and discomfort. |
| Laser therapy | The therapist can use a small device to direct low-level laser beams at these hardened tissues. This loosens the hardened tissues. |
| Manual therapy | The therapist may gently massage and gently pull this tissue from the top of the hand down. At this point, you may hear a 'click' sound as one of the cords breaks. Don't worry, this usually doesn't cause pain. This will allow you to move your hand more freely. |
When a cord is loosened in one place, the pain in that area may decrease, and you may feel more tightness and pain in another part of your hand. This does not mean that the cording is getting worse. It means that those areas are still tight. When the cord is loosened in that area, the pain will go away.
Take-Home Message
- Cording is a common side effect of breast cancer surgery. It's not your fault.
- The main symptoms are pain, tightness, and visible/felt stringy tissue extending from the armpit down the arm.
- Don't panic about this situation, talk to your doctor. He or she will refer you to an appropriate physical therapist.
- It is essential for speedy recovery to consistently perform the stretching exercises taught by the physical therapist at home, without any boredom .
- Even if your symptoms are completely gone, continue these exercises to keep your shoulders in good shape throughout your breast cancer treatment journey.
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