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Tightness and pain under the arm

November 10, 2009
by Gail Pekelis, MA, PT, CLT

          In our physical therapy practice we have observed patients experiencing Axillary Web Syndrome (AWS).  These are women who have undergone axillary lymph node dissection (ALND), who are experiencing post operative pain and limited range of motion associated with a palpable web of tissue extending from the affected axilla into the ipisilateral arm.

          This syndrome (AWS) is characterized by axillary pain radiating down the affected arm, shoulder range of motion limitation, and an axillary web of tissue most obvious post operatively when the patient tries to abduct (lift the arm to the side up towards the ear) her arm.   This web of tissue is often also called "cording" or "violin strings" due to its resemblance to tendons or a web of fine strings.

          The subjective complaints that are expressed about this axillary web cording  is that it feels like pulling causing tightness in the effected arm and shoulder. Limiting motion and causing pain.

          The current research on AWS appears to agree that this syndrome is related to lymphovenous injury during the ALND.

The removal of axillary lymph nodes could promote the AWS through multiple mechanisms.  It is possible that the more limited axillary surgery, with less disruption of the lymphatic and superficial tissues of the arm might help reduce the incidence and severity of AWS.

          This is a self-limiting condition and does resolve over several months.  There appears to be several treatments that may aid in the resolution of AWS, as well as conditions that appear to exacerbate this "cording."

          Specific soft tissue mobilization, manual lymphatic drainage and certain upper limb neural tension exercises are designed to reduce the cording tightness of the axillary web tissue. It also appears that this "cording" tightness can also be exacerbated by premature overstretching or straining of this tissue. This seems to slow down the resolution of the syndrome.


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