AWS can significantly affect comfort, mobility, and quality of life. The good news is with early, targeted therapy, AWS is highly treatable. At Ottawa Cancer & Lymphatics Centre, our therapists specialize in the early identification and effective treatment of cording, helping you regain range of motion, reduce discomfort, and return to your daily activities as quickly as possible. 

What is Axillary Web Syndrome?

Axillary Web Syndrome occurs when tight, cord-like structures form beneath the skin following cancer surgery, especially breast surgeries (such as mastectomy and lumpectomy), axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB). These cords typically begin in the armpit and extend down the inner arm toward the elbow—sometimes reaching as far as the wrist or thumb. Cording can also appear in the ribs or chest wall, and in some cases, may not be visible but still cause pain or restriction. 

Symptoms often emerge one to eight weeks after surgery, but they can also develop much later—sometimes months or years after treatment. For many people, AWS is painful and makes it difficult to lift the arm overhead, straighten the elbow, or participate in regular activities. Common symptoms of cording include: 

• Visible or palpable cords in the underarm, chest, or arm 
• Tightness or pulling sensations with movement 
• Pain when stretching or reaching overhead 
• Limited range of motion at the shoulder or elbow 
• Burning or tingling along the inner arm 
• Discomfort when lifting, dressing, or doing daily tasks 

Causes of Axillary Web Syndrome

While research is still ongoing, AWS is believed to result from inflammation or hardening of tiny lymphatic vessels that were damaged during surgery. These changes can cause surrounding connective tissue to form dense, rope-like cords. You may feel a single pronounced cord or several smaller ones. Some people experience burning sensations or pulling in the arm even if the cords aren’t visible. 

Because cording restricts movement, it’s common to avoid painful positions—but limiting movement can worsen stiffness and lead to loss of function or even complications like frozen shoulder. AWS can also interfere with radiation therapy, as treatment often requires the arm to be held in a raised position. 

How We Treat Axillary Web Syndrome 

Early intervention is key. At Ottawa Cancer and Lymphatics Centre, our therapists are trained in oncology rehabilitation, manual therapy, and lymphatic health, making them uniquely qualified to treat AWS. 

Your treatment plan may include: 

• Soft tissue mobilization and myofascial release 
• Scar massage and laser therapy 
• Nerve gliding and stretching techniques 
• Gentle range-of-motion exercises 
• Postural education and activity modification 
• Manual lymphatic drainage if swelling is present 

We’ll also guide you through personalized home exercises to support recovery and reduce the risk of cording recurrence. In most cases, symptoms resolve within 1–3 months of starting therapy, particularly when addressed early. 

If you’ve recently had breast cancer surgery or lymph node removal and are noticing pain, tightness, or visible cords in your arm or chest our therapists can assess your symptoms, provide a diagnosis, and build a customized treatment plan to help you regain motion, ease discomfort, and return to doing what you love.