Cording, also known as axillary web syndrome (AWS), is a condition that can develop weeks or months after surgery for breast cancer, particularly after lymph node removal in the armpit. It is caused by inflammation and scarring of the tissues that surround the lymph vessels, blood vessels, and nerves. Cording is characterized by the development of cord-like structures under the skin on the inner arm, which can cause a painful sensation and tightness that can reduce the range of movement of the arm and shoulder. The cords can be seen or felt when the arm is lifted to shoulder height or above the head. Cording can affect a persons ability to do many daily activities.

It is important to keep the arm and shoulder moving when cording develops to prevent further tightness, which can cause more serious problems. Doing gentle stretching exercises in the first weeks after surgery can help, as well as massage, physiotherapy, or low-level laser treatment by a lymphoedema practitioner. With appropriate physiotherapy and exercises, most cases of cording are fully resolved within a few weeks or months.

Cording is often under-recognized and left untreated, so it is important to raise awareness and inform doctors, particularly GPs, about cording. Women who have had lymph nodes removed during breast cancer surgery should be aware of the symptoms of cording, which include a sharp pain in the armpit when the arm is stretched and raised above shoulder level, and difficulty raising the arm any higher than the shoulder or extending the elbow all the way. If cording is suspected, a prompt referral to physiotherapy can accelerate healing.