Cording is the hardening of lymphatic vessels or veins. It begins with an inflammatory process that can arise from a bacterial infection, surgery, excessive or prolonged exertion or repetitive strain during exercise. The vessels alone can be the source of inflammation. After the inflammation subsides the vessels can harden, shorten or adhere to surrounding tissues. Cording can be connected to scar tissue. This hardened fibrotic vessel can be located anywhere in the body. Cording lesions may be found in the arm, leg, abdomen, groin or penis. The cording will usually run the length of the affected body part.
Signs and symptoms of cording are:
- painful or restricted ranges of motion
- visible and palpable cords that run in predictable patterns
- webbing in the armpit
- protective holding pattern of the affected limb
- a wrinkling of the skin along the length of the cord which is visible on extension of the limb
- a feeling of tightness
Axillary Web Syndrome (AWS) is cording that occurs specifically in the armpit. AWS might connect into the chest, run into the elbow or down to the thumb. AWS most commonly presents after lymph node removal, sentinel node biopsies or radiation therapy in the treatment of breast cancer. It is also common after liposuction of the chest or arms and with breast augmentation and reduction. It commonly occurs one to two weeks after surgery and usually resolves within three to eight months. In some patients, it remains persistent and needs ongoing treatment. AWS tends to present more in patients with a lower body mass index.
Treatment of AWS might include:
- specific stretches
- soft tissue manipulations to treat the adhesions
- quick stretching manipulations of the cords
- manual lymph drainage/lymphatic massage
- lymph kinesio taping
- low level laser therapy
- myofascial release
- nerve gliding
Some therapists will use heat and Swedish massage to treat cording. These treatments have produced effective results in loosening tensions in tissues but for those with lymphatic health concerns they might be risky as they increase local blood flow and may place an extra burden on the lymphatic system. Techniques that tend to lower the lymphatic load are preferred. In most cases cording will take just one or two treatments to resolve. The pain from cording is usually relieved after one treatment. For some people, cording may resolve and reappear later on. For others, cording may be persistent and requires ongoing treatments.
AWS may be misdiagnosed as frozen shoulder by a professional not familiar with the condition. In such cases the treatments for frozen shoulder would not be appropriate for the condition of AWS. These treatments may be painful and offer little effectiveness for AWS and may also be triggers for lymphedema. If you think you might have axillary web syndrome, schedule an appointment with one of our lymphatic therapists as soon as possible.
Denise Drisdelle is a registered massage therapist and co-founder of FLOW Lymphatic Health Services.