What Is Cording (Axillary Web Syndrome)?

Written by Carlie Olenick, WebMD Editorial Contributor
Medically Reviewed by Laura J. Martin, MD on July 20, 2025
8 min read

Cording — also known as axillary web syndrome (AWS) — often happens after your doctor removes lymph nodeds under your arm. A cord or web of cords can form under the skin on the inside of your arm. The cord-like tissue can extend from your shoulder to your elbow, or into your palm.

You can usually feel this cord as you extend your arm away from your body. The rope-like structure can also appear near your ribs or chest wall. You may not always see the cord. But it can still limit your movement and cause pain.

Cording is likely caused by injury to your lymph vessels, blood vessels, or nerves under your arm. In fact, about 86 in 100 people who have breast cancer surgery to remove lymph nodes get cording.

And you're at higher risk for cording if you're younger, have a lower BMI, and get multiple lymph nodes removed. This rope-like tissue can cause discomfort and make using your arm harder. Find out more about how cording happens, the symptoms, and treatments that can help.

Your lymph system forms a network of organs, vessels, and tissues to protect you from infection. It's a key part of your immune system. Similar to blood vessels, your lymph vessels and nodes move a watery fluid (lymph) through your body.

But your lymph nodes are actually tiny, small glands that help you fight infection and disease.‌ Your lymph nodes collect and drain extra fluid from your body.

Your lymph organs and glands include your:

  • Tonsils
  • Adenoids
  • Thymus
  • Spleen
  • Bone marrow
  • Lymph nodes and vessels
  • Lymph tissues in your small intestine

Your lymph system carries white blood cells all over your body. The system protects and destroys invaders like viruses. The lymph fluid flows through the nodes. They act like tiny filters to get rid of damaged cells and bacteria.

Sometimes, as your lymph nodes try to filter out cancer cells, some types of cancer can spread to your lymph nodes under your arm. But your doctor can remove them.

Experts aren't exactly sure what causes cording. But some research suggests injury to bundles of lymph nodes, blood vessels, and nerves under your arm can cause cording.

The connective tissue and nearby structures can get injured if you have:

  • Surgery to remove lymph nodes with cancer
  • Infection
  • Other medical syndromes, such as Mondor's disease (a rare breast inflammatory condition)

‌Cording commonly occurs as a side effect of removing lymph nodes with cancer under your arm. Your doctor may suggest a biopsy first. A biopsy removes a small piece of tissue to test for cancer cells.

There are two types of biopsy procedures:

  • Sentinel lymph node biopsy (SLNB) to remove one to four nodes
  • Axillary lymph node dissection (ALND) to remove many lymph nodes

Many breast cancer treatments involve both procedures. But if your SLNB doesn't show cancer, your doctor likely won't do an ALND.

Sometimes, cording can occur even after just removing the breast tumor. But the risk increases if more lymph nodes are removed. But even if your surgeon removes one node, cording can happen. That's because after an axillary (underarm) lymph node is removed, any lymph vessels connected to it can harden. And this can cause axillary web syndrome.

But sometimes, axillary web syndrome can result from injury or inflammation.

"Although rare, cording can happen in people without a history of breast cancer or axillary surgery," says Franchesca König, MD, medical director of Cancer Rehabilitation Medicine at UCHealth in Aurora. "It can occur following intense physical exertion or trauma — triggered by local injury to or inflammation in your lymph system."

With axillary web syndrome, you may not be able to lift your arm above your shoulder.

If you have cording, you may first notice:

  • Tenderness under your arm
  • A feeling of tightness from the surgery site down to your elbow or even wrist
  • Tightness that may also run along your chest
  • Shooting pain in your armpit when you raise your arm over your head
  • Stiff or painful shoulder
  • A cord running from your armpit down your arm

AWS typically appears a few weeks after surgery. There have been a few cases where it didn't start until months or possibly years later. And your symptoms can change over time. The cord or cords thicken until you can feel them and see them under your skin. 

As AWS advances, your symptoms can worsen and include: 

  • Tightness and pain
  • Difficulty raising your arm above your shoulder
  • Severe pain that may prevent you from fully straightening your elbow 
  • Trouble doing your normal daily activities
  • Frozen shoulder

If you are in radiation therapy, cording can be an even bigger problem. That's because you'll need to lift your arm over your head.

Your doctor will start with a physical exam and review your medical and surgery history. They may ask you to extend your arm. and gently feel the area under your arm. Your doctor may press where you feel pain.

They may feel the corded tissue with their fingers, too. The cords in your arm may feel like violin strings. Sometimes, you can have cord-like nodules that spread to the back of your hand. The nodules usually cause discomfort or numbness.

Your doctor may also move your arm and ask you:

  • When the pain started
  • When you noticed the cording
  • When you notice your symptoms the most
  • If your symptoms have gotten better or worse

Treatment can help improve your shoulder's range of motion. Physical therapy exercises can also help lower fluid buildup (edema). 

Your doctor may suggest treatments such as:

  • Stretching and strengthening exercises to help your nerves move better
  • Medications
  • Laser therapy
  • Manual therapy and massage to drain fluid buildup
  • Compression
  • Surgery

Symptoms usually improve after a few therapy sessions. But full recovery can take a few months. Ask your doctor to suggest a therapist, nurse, or doctor who knows about cording.

Stretching exercises for cording

If you can regularly do your special exercises, you'll speed up your recovery. The exercises help you stretch the cords and allow you to move your arm more freely. Your physical therapist can begin with gentle, gravity-assisted pendulum exercises. This type of stretch can help lower your pain. And your physical therapist can teach you at-home exercises, too.

Medications to treat AWS

The exercises can be uncomfortable at first. Your doctor may suggest an NSAID, such as ibuprofen, to lower pain and inflammation. The medicine can help ease discomfort during therapy or exercise. Keep in mind that pain tells your body how far you can safely stretch to prevent injury.‌

Laser therapy to break up scar tissue

Your therapist may use a small hand-held device to apply low-level laser beams to your cords. The laser therapy can break up hardened scar tissue and improve your arm movement. And some studies suggest laser therapy can lower fluid buildup in your arm, too.‌

Manual therapy options 

Massage and moist heat can help soften the cords. Massage methods can include myofascial release. Your therapist may gently pull on the tissue in your arm. They'll start in your upper arm and work down toward your wrist.

This may cause a cord to snap with a popping sound. It doesn't usually hurt if this happens. And the massage may help you move your arm more freely. Your therapist can also apply moist, warm pads to your cords. Although prolonged heat can cause fluid buildup, therapists use it as a short-term treatment. Massage also helps reduce any fluid buildup.

When a cord releases in a certain area, that part of your arm likely feels better. But other parts of your arm might feel even tighter or more painful. That doesn't mean your AWS is getting worse. It just means those spots are still stuck. 

Your pain can ease once the cord in that area releases. Even after your symptoms are gone, continue your stretching exercises . This helps keep your shoulder in good condition as you complete your cancer treatments and recover.

Surgery for cording

Sometimes, your cords can affect your quality of life and interrupt your daily activities. With serious cording, your doctor may suggest surgery to remove your cords. But removing your corded tissue can raise your risk for fluid buildup. Talk with your surgeon about the best treatment plan for your AWS.

Although axillary web syndrome can cause discomfort, it usually isn't serious. Sometimes, it goes away on its own. But without treatment, your muscles and tissues can tighten to cause frozen shoulder.

If you have cording symptoms, talk to your doctor about treatment. Stretches and exercises can help relieve symptoms and lower the risk of frozen shoulder.

Arm and shoulder exercises can help axillary web syndrome. Always talk to your doctor or physical therapist about how much shoulder and arm movement is safe. Right after surgery, you may need to heal before starting exercises.

Here are a few exercises that you may be able to do at home:

Butterfly stretch:

  1. To start, lie down on your back with your knees bent on the floor. 
  2. Extend your arms above your head and clasp your hands together.
  3. Next, point your elbows toward the ceiling and slowly move them apart.
  4. Move your clasped hands behind your head, with your arms on either side of your head.
  5. Breathe and hold for five seconds.
  6. Return to the starting position and repeat three to five times.

Snow angels:

  1. Start by lying on your back.
  2. Extend your arms straight out to create a "T" shape.
  3. Slowly move your arms up.
  4. Try to extend your arms above your head, like making a snow angel.
  5. Slowly, move your arms back to your sides.
  6. Remember to breathe.
  7. Repeat three to five times.

Nerve glides (nerve flossing):

  1. While standing, bring your arms up to shoulder height (or as high as you can).
  2. Keep your elbows straight.
  3. Bend your hands back and forth at the wrist.
  4. You'll feel a gentle stretch or tension.
  5. Breathe.
  6. Relax for two to three seconds.
  7. Repeat three to five times.

If you don't feel the stretch, then after extending your arms, raise your shoulders to your ears. Then, bend your hands back and forth to stretch.

Axillary web syndrome (AWS) causes a cord or a web of cords, usually after lymph node removal under your arm. The violin string-like cords extend from your shoulder to your elbow or palm. Stretching and exercise can help ease your discomfort, lessen fluid buildup, and improve your range of motion. Talk to your doctor about physical therapy treatment for cording.

Who is most at risk for cording?

It’s still unclear, but you may have a higher risk for cording if you:

  • Have a lower BMI
  • Have had more underarm lymph nodes removed
  • Are younger

Can you get axillary web syndrome without cancer?

Yes, injury, infection, and some inflammatory syndromes can lead to cording. It's called idiopathic AWS (happens for unknown reasons). Although rare, these cases can happen without underarm surgery or injury.

How can I prevent axillary web syndrome?

Although you can't usually prevent cording, treatment can improve your symptoms. Ask your doctor about physical therapy for cording. It can help ease discomfort, improve range of motion, and reduce fluid buildup.

What massage techniques help axillary cording?

Your physical therapist may use a massage technique called myofascial release. But one review found myofascial release may only offer short-term relief from your symptoms, while exercise and stretching tend to work longer.