Axillary (armpit) cording is a painful condition that limits arm movement for some women following breast cancer surgery.
"Even though I do my arm exercises – when I reach up I still get pain into my arm and the tightness into my armpit hasn’t gone away. When I look in the mirror I see a really tight band of tissue." This is a common report from women experiencing post-breast cancer cording (axillary web syndrome).
Regaining normal arm movement and strength can be painful and difficult for some women after breast cancer surgery.
An Australian study of women 6 years after their breast cancer surgery found approximately 50% of the women experienced at least one adverse shoulder/ arm symptom. This level of experience and this intensity of dysfunction are now commonly reported across many countries and is the reason behind calls for increased access to breast cancer specific rehabilitation.
Research has been slow to take up the challenge of identifying and measuring real issues such as the degree of post- surgical scar tissue and post- surgical axillary cording, otherwise known as axillary web syndrome (AWS), that extends from the breast scar tissue into the armpit or down into the arm. Current research has focused on pain experience, performance of specific tasks, lymphoedema measures, simple shoulder movement measures and questionnaire responses- not the degree of breast scar tissue.
Some women experience such significant scar tissue and cording that they are unable to get their arm above their shoulder and are not able to reach behind them. Not only is it painful and causes weakness, but for some women embarking on radiotherapy- they are not even able to get their arm out of the way for the radiotherapy.
Though research focused on axillary cording is limited, a few case studies suggest that specialized physical therapy can be beneficial in restoring much better movement.
So how do we help more women get assess to treatment for this problem? How do we get more interest in and action on Breast Cancer Rehabilitation? I believe we need to increase access to information.
I have launched a project – Share Cording (AWS) Protocols Project 2014 – as a means of sharing single case studies about cording and how it may respond to specialized treatment. Therapists across the world are invited to participate by submitting their case study or by simply viewing how others treat cording.
I am expecting that the project will be picked up at a variety of levels as it will be available on Youtube. Women across the world may be able to access the project information and possibly see cases that may have similar cording to their own experience. For therapists entering into the new area of Breast Cancer Rehabilitation, there is visual evidence of before and after treatments. For therapists looking to benchmark their treatment regime or protocol, then they can see the protocols used in the case study and even contact the therapists who have put the case studies on the project. Researchers will be able to view many different presentations of cording that therapists are seeing in their clinics. There are currently 5 case studies from 3 very experienced therapists, from 3 very different countries.
I hope that through this project, at least one more woman will be able to get the treatment they need to help reduce the pain and dysfunction that can occur after breast cancer treatment.
Case studies are not representative of the entire population but are real people, with their own version of cording, receiving real treatments. We especially thank the women for sharing their stories of treatment in this project.
Check out the project:
Talk to your therapists and health care professionals about the project.
Be part of the project by sharing the information.
Cording can be treated successfully.
Contact person: Denise Stewart ( Occupational Therapist) firstname.lastname@example.org