Axillary Web Syndrome (AWS): Recognizing Cording After Breast Cancer Surgery

by Alexandra Wiley  MScPT
Registered Physiotherapist
updated Mar 12, 2026

If you’ve recently had a mastectomy or axillary lymph node removal, you might notice tight, painful “cords” under your armpit limiting your shoulder movement. Axillary Web Syndrome (AWS) is also called cording, and is a common but treatable complication affecting up to 20–30% of patients following surgery. Physiotherapy soon after your procedure can significantly restore mobility and reduce your risk of lymphedema (Leduc et al., 2010). Here’s what you need to know.

What Is Axillary Web Syndrome?

Axillary Web Syndrome (AWS), also known as cording, is a condition that can develop following the removal of lymph nodes in the armpit (or axillary) region and often as a result of breast cancer surgery. It is more common than many people realize and appears as tight, guitar string-like “cords” that run from the armpit down toward the inner arm or forearm.

These cords can be tender, painful, and restrictive, often making it difficult to lift the arm or perform everyday activities. AWS typically develops 3-4 weeks after surgeries that involve lymph node removal or a mastectomy. As it is associated with an increased risk of lymphedema, early assessment and intervention are essential to maintain mobility and prevent secondary issues.

How to Know If You Might Have AWS

Have you recently had a mastectomy or axillary lymph node removal?
If so, check for the following symptoms:

• Stiffness or pain when lifting your arm sideways or overhead
• A visible or palpable “cord” extending from your armpit down your arm
• Swelling, numbness, or tingling in the affected arm
• Tightness or pulling sensations through the underarm or forearm
• Additional surgical incisions around the upper arm or chest area

During an assessment with our cancer care physiotherapists, these symptoms and risk factors are reviewed in detail. It is important to establish baseline measurements early (even before symptoms appear) which allows for a personalized treatment plan, proactive management, and improved outcomes.

Treating Axillary Web Syndrome

Early treatment of AWS is key to restoring function and preventing complications such as lymphedema, frozen shoulder, or chronic pain. The longer the condition has set in, the harder it can be to reverse the problem.

While there is no universal treatment standard, physiotherapy has been shown to be highly effective in reducing discomfort and improving mobility. (Agostini et al., 2021)

Goals of physiotherapy treatment:

• Reduce pain and tenderness
• Improve shoulder and arm mobility
• Enhance lymphatic drainage and circulation
• Release or lengthen cord adhesions

Physiotherapy sessions may include hands-on techniques such as gentle soft tissue release and range-of-motion exercises, paired with guided mobility and stretching programs to perform at home. Early identification and management of AWS can significantly improve outcomes following surgery.

References

Agostini, F., Attanasi, C., Bernetti, A., Mangone, M., Paoloni, M., Del Monte, E., Mammucari, M., Maggiori, E., Russo, D., Marzo, R. D., Migliore, A., & Paolucci, T. (2021). Web Axillary Pain Syndrome-Literature Evidence and Novel Rehabilitative Suggestions: A Narrative Review. International journal of environmental research and public health, 18(19), 10383. https://doi.org/10.3390/ijerph181910383

Fourie W, Robb K. Physiotherapy Management of Axillary Web Syndrome following breast cancer treatment: Discussing the use of soft tissue techniques. Physiotherapy 2009; 95(4): 314-20.

Harris SR. Axillary Web Syndrome in Breast Cancer: A Prevalent but Under-recognized Postoperative Complication. Breast Care. 2018;13(2):129-32.

Leduc, O., Sichere, M., Moreau, A., Rigolet, J., Tinlot, A., Dare, S., Wilputte, F., Strapart, J., Parijs, T., Clement, A., Snoeck, T., Pastouret, F., & Leduc, A. (2010). Axillary web syndrome: Nature and localization. Lymphology, 42(4), 176–181.

O’Toole J, Miller CL, Specht MC, Skolny MN, Jamallo LS, Horick N, et al. Cording following treatment for breast cancer. Breast Cancer Research and Treatment. 2014;140(1):105-11.

About the author

Alexandra Wiley

Physiotherapist Learn More about Alexandra Wiley