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October, is Breast Cancer Awareness Month

Axillary web syndrome (AWS), often called cording, can occur as a result of sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). The axillary, or underarm, lymph nodes are removed in both procedures, either a few (SLNB) or many (ALND). At least one of these operations is required for most women with breast cancer. Cording can also be caused by scar tissue after breast surgery that was performed over the chest area to remove the cancer.


This problem frequently appears days, weeks, or even months following surgery. The axillary (scar, which runs along the inside of the arm, often past the elbow and as far as the wrist, causes a tightness. It's possible.


It's also possible for it to run down the trunk and into the chest wall.

It thickens and becomes felt and apparent over several weeks, resembling a taut cable beneath the skin. It could be a single cord or several cords, forming a thick web of hardened tissue in the axilla.



Even before a cord is apparent, the initial sign of cording is tightness and soreness in the arm that hampers movement. It's critical to explain and reassure the patient that the problem can be fixed. As soon as possible, a referral to a specialized physiotherapist should be made. If cording isn't treated, it can lead to immobility, long-term pain, and a frozen shoulder. Exercises and massage treatments to stretch and soften the chord are the cornerstones of treatment.


The exercises can be unpleasant, but keep going until your arm movement improves and your pain goes away. Before physiotherapy or exercises, painkillers might be used if necessary. Cording may appear to be an afterthought in the whirlwind of breast cancer diagnosis and treatment. However, from the patient's perspective, recovery will not be complete as long as pain and arm movement are restricted. Improved cording awareness among doctors and breast cancer patients will help patients heal and avoid persistent pain.


Treatment would include exercises and massage such as:

  • Myofascial release. Myofascial Release softens and elongates the strained tissue around the vessels and increases the pliability of the vessel walls themselves, which are held together by fascia. Fluid in the area flows more easily, and the affected areas typically become much healthier and more comfortable

Below are some examples of stretches to aide in mobility and flexibility in the affected arm:


1. Median nerve stretch


2. Pectoral muscle stretch


3. Open book stretch


4. Child pose



5. Upper back mobility open arm stretch




Reference:

1. http://www.trianglebodytherapy.com/blog/2015/10/2/myofascial-release-for-breast-cancer

2. https://www.breastcancer.org/treatment/side_effects/aws

3. https://bjgp.org/content/69/685/395

4. https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/cording-after-surgery-for-breast-cancer

5. https://www.healthline.com/health/axillary-web-syndrome

6. https://www.amjmed.com/article/s0002-9343(17)30006-2/fulltext

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