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Breast surgery and physiotherapy

Specialist Musculoskeletal Physiotherapist Katy Holden from the Physiotherapy Unit at the Hospital of St John & St Elizabeth, explains why it is important for those who have had Breast surgery to recognise symptoms of ‘Cording’ and how this common side effect can be successfully treated with Physiotherapy.

Hot topic: Cording also known as Axillary Web Syndrome (AWS)

Following breast surgery all patients will be given a neck and shoulder exercise routine to perform to help prevent common post surgical problems, including; cording, neck pain, frozen shoulder and shoulder impingement. This article focuses on cording/ AWS which is a very common complaint.

Who gets Cording/ AWS?

Cording can occur following a sentinel node biopsy (where a few lymph nodes are taken) and more commonly following an axillary lymph node dissection (where many lymph nodes are taken). As well as this, scar tissue from breast surgery to the chest area can also be a contributing factor.

How will I know if I have Cording/ AWS?

Symptoms to look out for:

  • Rope- or cord-like structures appear in the under arm
  • Usually the cords are raised but this is not always the case
  • Pain/ tightness from the underarm to the inside of the elbow
  • Sometimes cords appear on the torso or go down the arm as far as the wrist
  • You may experience reduced movement when elevating the effected arm or restriction across your chest

What causes Cording/ AWS?

The cause of cording is not yet fully understood. The current thought is that surgery to the underarm and chest causes trauma to connective tissue. It is believed that the lymphatic fluid becomes solidified and this causes scarring of the bundles of blood, lymph and nerve vessels. The vessel bundles then become hardened and take on a rope/ web appearance and can restrict the motion of the shoulder and the chest.

Will the Cording/AWS improve over time?

In the majority of cases cording/AWS resolves within a few months, however there are some reported cases that last up to 1 year. For people that require radiotherapy after surgery, cording can prevent them adopting the required treatment position. In this case, or if the cording is preventing you from performing your normal activities, physiotherapy can speed up your recovery and restore normal movement and strength.

What does Physiotherapy for Cording/AWS involve at The Physiotherapy Unit at the Hospital of St John and St Elizabeth?

Physiotherapy performed at the Physiotherapy Unit for Cording/ AWS will include a variety of techniques such as; stretches, massage, manual therapy and strengthening. The physiotherapist will be able to offer specialist advice to the patient.

Book an Appointment at The Physiotherapy Unit:

If you would like a consultation with a Physiotherapist with a special interest in Cording/AWS then please contact The Physiotherapy Unit at The St John and St Elizabeth Hospital by calling 020 7806 4010 or by email on physiotherapy@hje.org.uk.

Flexible appointment times are available.

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Breast surgery and physiotherapy
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