Axillary Web Syndrome (AWS /cording) has been recognized as a movement limiting complication after breast cancer surgery. Quality research is lacking regarding AWS. The aim of this research is to explore commonalities and variances of physical intervention programs used by experienced therapists, to guide research and clinical practice.
Content analysis was applied to case studies submitted by therapists to an international project - Share Cording Protocols Project (SCPP 2014-15). Therapists provided data on movement restrictions, treatment interventions, timeframes and outcomes. Photographic evidence of cording before and after treatment accompanied the data. Peer and member checking were applied.
Four therapists provided case studies to SCPP: 10 episodes of AWS, 3 episodes of trunk cording. AWS and pectoral muscle tightness were recorded at initial assessment in 11/13 episodes. Treatment sessions were commonly 45- 30 mins. Treatment frequency varied from 1-20 sessions and 1day- 18 weeks. Shoulder flexion and abduction gains ranged from 20- 100 degrees and 60- 130 degrees respectively. Therapists commonly used massage along cord and at adhesion, breast and axilla scar treatments, pectoral muscle stretch and a home program. Cupping and low level laser were innovative treatments used by single therapists. Exercise advice only and lymphatic massage were not used. Cording was still seen, although less, at the end of treatment in 12/13 episodes. Cording across the elbow created shoulder range variances dependent on measurement method. Cording occurred either soon after surgery, during chemotherapy, during or after radiotherapy and influenced therapy frequency in 7/13 episodes.
These case studies highlight severity and variability of post breast cancer cording. Sound movement gains in shoulder flexion and abduction were achieved by therapists using a combination of scar, muscle and fascial release techniques. AWS evaluation methods, treatment methods including frequency, links to local scar and pectoral muscle need further research.